Agency Profile
Please fill out the form below if you are interested in obtaining an appointment with Fingerlakes.
(All information provided will be kept in strict confidence)

General Information
Agency Name:
Mailing Address:
City:
State/Zip:
Main Office Location:(if different)
City:
State/Zip:
Branch Office Locations:
Phone:
Fax:
Email:
Agency owner(s) or key contact:
Federal ID Number:
P&C Agents License Number:
Year Established:
Does agency carry E&O Insurance? Yes No
Losses past three years? Yes No
Business Structure: Corporation Partnership Individual Other
Membership in Professional Organizations: PIA IIA Other



Marketing Information
2006 Total Premium $ Commercial  % Personal   %
2005 Total Premium $ Commercial   % Personal   %
2004 Total Premium $ Commercial   % Personal   %



Primary Marketing Territories
Rural %  Small Town %
Suburban  %    Urban   %
Are there any cluster, group or brokerage arrangements with other agencies? Yes No

if so, with whom?

Is there a"new Business" prospecting plan in place? Yes No  
Is there a renewal retention program in place? Yes No  



Growth Goals
How did you hear about Finger Lakes?

Which products are targeted for agency growth with FLFC?

Anticipated Volume with FLFC:

during appointment year $

for first full year $

second full year $
third full year $



Carrier Information

List all standard carriers

List Written Premium / Loss Ratio
2006 2005 2004
1. $/% $/% $/%
2. $/% $/% $/%
3. $/% $/% $/%
4. $/% $/% $/%
5. $/% $/% $/%
Is there potential for book transfer? Yes No
Company Volume



Changes in the past three years
Company Added Terminated Reason
Company Added Terminated Reason
Company Added Terminated Reason
Company Added Terminated Reason



Key Personnel Information
Agency Owner(s)
Total number of employees
Number of outside sales
Number of CSRs
Key Agency Personnel Title/Position Prof. Designations Yrs w/Agency Yrs in Ins. Licensed?

Yes No

Yes No

Yes No

Yes No

Yes No

References:

Comments: