Agency Brokerage Consultants

Insurance Agency Inquiry Questionnaire

*All Fields Are Required.

What type of agency are you looking to acquire? (Select all that apply)

P&C Life Health

Commercial Lines Personal Lines Financial Services

Other

What range of commissions are you looking for in an agency to acquire?

$ to $

What is the maximum you are willing to invest for a down payment?

Are you currently working with any lenders for an acquisition? If so, which lender(s)?

How soon would you like to acquire an agency and in what geographic area?

Months

Geographic Area

Are you currently licensed to sell insurance? If so, please list the states and the type of licenses you hold.

* Entered your information into all fields and continue on to Contact Information.

*All Fields Are Required.

Name:

Company:

Street:

City:

State:

Zip:

Phone:

Cell:

Email:

Please tell us how you found out about Agency Brokerage Consultants.

*Make sure you have entered your information into all fields.