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Take the first step towards selling Safeco insurance
Once you complete the form below, a Safeco representative will respond in 48-72 hours with next steps.
* Indicates a required field.
Applicant Information
First name*
Last name*
Agency address
Agency name*
Street Address*
City*
State*
AL
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CT
DC
DE
FL
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ID
IL
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IA
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ZIP code*
Agency contact
Phone number (555-555-1212)*
Email address*
Confirm email address*
Website URL (www.yourcompany.com)*
Agency experience
Agency background*
Start-up
Mature IA experience, previously appointed
Moderate IA experience (3-4 years)
Mature IA experience (5+ years)
Moderate IA experience, previously appointed
Mature IA experience, previously appointed
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Years in business*
Less than 6 months
6 months - 1 year
1 - 3 years
More than 3 years
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Personal lines written premium*
Less than $100k
$100 - $1million
$1million - $5million
More than $5million
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Total written premium*
Less than $100k
$100 - $1million
More than $5million
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Top 3 personal lines markets
1
Company
Company name*
Written premium (digits only)*
2
Company
Company name
Written premium (digits only)
3
Company
Company name
Written premium (digits only)
How many total personal line carriers business
Personal line carrier you write business for*
0 - 3
4 - 10
10 - 15
More than 15
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