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*First Name:     *Last Name:  
Street Address:
City:      State:     Zip Code:  
*Phone Number: 
*Email: 
Who were you referred by?  
Have you ever used a Lead source before?  
 
1. Do you have errors and omissions coverage?    Yes No
 
2. How long have you been selling insurance full time?    years
 
3. On average, how many insurance cases do you write each week or month? per Week
 
4. What percentage of your insurance business is within each of the following categories?
Auto insurance %
 
Health insurance %
 
Home/Property insurance %
 
Life insurance %
 
Other insurance %
 
 

5. Now, thinking only of your health insurance business, what percent
of your sales for health insurance comes from Individual versus Group business?

Individual % of business
Group % of business
 
6. What type of insurance do you specialize in?
 
7. Which carriers are you actively using now?
 
8. What kind of support do you need?
 
9. What is your key frustration in your business?
 
10. Are you technically savvy (computers, Internet, etc.)?  Yes  No  Somewhat
 
11. Approx how many clients do you have?  
 
12. Would you be interested in personalized mailing piece? Yes  No
 
 
29. Do you have Sub-Producers? Yes No     How many?
 
Check the boxes below to find out more information on our plans.
     
1. Ideas to Make You Successful
2. Marketing Support
3. Solutions for the Health Care Crisis
4. Business – Building Support
5. Leads Available
6. Sales programs – Cross Selling and Total Account Development
7. Opportunity to Open New Distribution Channels
8. Marketing with a Bank
9.

Marketing for Groups

10. Co-Op Advertising
11. Computer Assistance and Training
12. Web Page Development
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17. Looking for GA’s and MGA’s
18. Referring Agents
19. Get Paid for Your Agency
20. Protect Your Commissions
 

 
Best Value Insurance Agency, Inc.
1700 S. Campbell, Suite C
Springfield, Missouri 65807-2000
Phone: 417.863.1096
888.755.8220
Fax: 417.863.8640
communication@bviai.com
 

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