Agency Appointment Request

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Agency Appointment

Nautilus Insurance Group

7233 E Butherus Dr.

Scottsdale, AZ 85260

Agency Name

Surplus Lines License Number

Agency Primary Location Address

Mailing Address (if different from above)

State(s) Agency Currently Holds Surplus Lines License In

Primary Contact’s Name & Title

Primary Contact’s Email

Primary Contact’s Phone Number

How Many Years has Agency Been In Business?

How Many Years in Surplus Lines?

Your Excess & Surplus Lines Team Includes How Many Employees?

Of Those, How Many are New Business Producers?

What is the Total Excess & Surplus Lines Premium You Write?

What Percentage of Premium is Binding vs Brokerage?

What Percentage of your Book is General Liability Versus Property?

What is your Current State Footprint (from Largest Premium to Smallest)?

What are the Top Five Classes of Business your Agency Currently Writes?

How Many Excess & Surplus Lines Binding Carriers are Currently Appointed with your Agency?

Who are your Top Five Binding Carriers

What are you Currently Looking for in a New Carrier Appointment?

How Did You Hear About Nautilus?

Where Do You See Nautilus Fitting Into Your Agency’s Current Book?