Professional Lines Underwriting Specialist, Inc.
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Agency Profile Application

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Applicant Information

Agency Name:* 
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Firm Type:* Corporation  Partnership 
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Please advise the names and titles of your agency's personnel, including principals and partners:

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Accounting Information
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With whom should we schedule appointments to visit your agency?


Please list the states in which your agency and/or individuals in your office hold resident or non-resident licenses and provide the assigned number for each license.

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Please break down your agency's premium volume:
Commercial Lines:
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Life & Health
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Approximate commercial lines volume:
E&O:
D&O:
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Please provide the top five Standard Lines Carriers your agency represents

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Please provide the E&S/Wholesale Brokers/MGAs your agency represents

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Are you affiliated with any other agency or organizations? If so, who?
E-MAIL

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Contact Us
716 Congress Avenue, Suite 100
Austin, Texas 78701 Map 512·474·0404 · 800·880·1019
info@prolines.com