Become an Agent

Become an Agent

Please be aware that agencies who want to represent EAIG must go through a highly selective appointment process. We are looking to partner with mid-size to large agencies who share our belief in offering clear service differentiation. As a result, we limit the number of appointments available in each geographical region based upon current market penetration. The questionnaire below is the first step in determining the suitability of an agency appointment. A marketing representative from your region will review your submitted questionnaire and contact you regarding the status of your request. Thank you for your interest!

Prospective Agent Contact Us Form

Please complete the form below and click the Submit button.

Required fields are indicated with a red asterisk (*)

General Agency Information

Name *  
Email *    
Agency Name *  
Year Agency Established *      
Mailing Address *  
City *  
State *
 
Zip *  
 
Main Location Address *  
City *  
State *
 
Zip *  
 

Other Location Addresses 1.
2.
3.

Office Phone *    
 
Office Fax *  
 
Agency Website Address *    

What state(s) is/are your Agency Licensed in? *
Select All  UnSelect All





Business Focus (%):
  Commercial *         Benefits *         Investments *      
                                                     

Number of Employees:
Commercial Department *   
 

Number of Producers:
Commercial Department *   
 

Commercial Lines Strategy

Total Commercial Volume and Total Workers' Compensation Volume
Commercial *   
(in millions)
 
WC *   
(in millions)
 

Top 3 Workers' Compensation Carriers 1. Name *   Year Appointed *     
               
    Premium Vol. *       Loss Ratio *   
2. Name *   Year Appointed *     
               
    Premium Vol. *       Loss Ratio *   
3. Name *   Year Appointed *     
               
    Premium Vol. *       Loss Ratio *   

Top 3 Package Carriers 1. Name *   Year Appointed *     
               
    Premium Vol. *       Loss Ratio *   
2. Name *   Year Appointed *     
               
    Premium Vol. *       Loss Ratio *   
3. Name *   Year Appointed *     
               
    Premium Vol. *       Loss Ratio *   

Target Classes/Niches/Areas of Focus *

 
Retention Strategy *

 
New Business Development Strategy *

 
Strategy for Hiring/Developing/Retaining Producers *

 

Average Account
Size Targeted *
  
Average Agency Retention Rate *  
Agency Competitors *

 

What state(s) are you Targeting for Workers' Compensation Production?
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Please contact us at 1.855.533.3444, ext. 1659 or BecomeAnAgent@eains.com if you do not receive a response to this questionnaire within 7 business days.