Commercial Lines Questionnaire

Prospect Name

First Name Last Name

What lines of coverage do you currently have?

Phone

Email

Address

Street Address Address Line 2 City State ZIP Code

Website

How many years have you been in Business?

Renewal Date

Can you provide me with a copy of your Loss Runs?

What is your annual Revenue?

Who is your current broker?

How long have you been with them?

What services does your current broker provide?

Do you regularly have a mid-year or pre-renewal meeting? What do you find valuable from the meeting or process?

Have you ever been taken by surprise by an unexpected rate increase?

Do you have a clear understanding of how the renewal was calculated and how your lost history / mod factor can affect future premiums?

How Many Employees do you have?

Are your employees safety conscious? How do you measure the results?

Do you have a safety handbook?

What is working well?

What is your biggest concern?

How did you hear about First Security Company, Inc.?

This field is for validation purposes and should be left unchanged.

Tell Us A Little About Yourself.