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First Name:

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Last Name

Organization Name:

Street Address:

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E-mail Address:

Book of Business

P&C Book of Business ($1,000):

Agency-Billed (%):

Direct-Billed (%):

No. of Producers:

No. of CSRs:

Commercial Lines:

Personal Lines:

Accounting Personnel (Number):

Current Receivables Turnover Ratio:

Trust Account Management

Interested in TA Technology (Y/N):

Yes   No

Interested in the Outsourcing Model (Y/N):

Yes   No

Priority of Desired Operational Improvements

Better control over fiduciary funds:

High   Low     Not a priority

Higher agency profits:

High   Low     Not a priority

Free CSRs time:

High   Low     Not a priority

Reduce operating capital requirements:

High   Low     Not a priority

Add value to customer service:

High   Low     Not a priority

Better agency-client relationship:

High   Low     Not a priority

Better agency-carrier relationship:

High   Low     Not a priority

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