Become An Indiana Farmers Insurance Agent | Indiana Farmers Insurance

5 years or more selling in the independent agency channel
3-5 years selling in the independent agency channel
Less than 3 years selling in the independent agency channel
Former captive / exclusive agent, new to IA channel
I am a start-up agency

First Name*:
Last Name*:
Years In Insurance*:
State*:
Are you licensed in other states?*:
Agency Name*:
Street Address*:
City*:
State*:
Zip Code*:
Phone Number*:
Email Address*:
Tell us about your experience in the insurance business.*:	5 years or more selling in the independent agency channel 3-5 years selling in the independent agency channel Less than 3 years selling in the independent agency channel Former captive / exclusive agent, new to IA channel I am a start-up agency
Number of employees in your agency*:	5 or less 6 to 10 10 to 25 More than 25
Number of personal lines producers in your agency*:	5 or less 6 to 10 More than 10
Number of commercial lines producers in your agency*:	5 or less 6 to 10 More than 10
Number of farm lines producers in your agency*:	3 or less 4 to 6 more than 6
Number of CSRs in your agency:*:	5 or less 6 to 10 More than 10
Has your agency been appointed in the past with Indiana Farmers?*:	Yes No
Personal lines written premium in your agency*:	Less than $200,000 $200,000 - $1Million $1Million - $3Million More than $3Million
Commercial Lines written premium in your agency*:	Less than $200,000 $200,000 - $500,000 $500,000 - $2Million More than $2Million
Farm Lines written premium in your agency:*:	Less than $200,000 $200,000 - $1Million $1Million to $5Million More than $5Million
Total written premium in your agency:*:	Less than $200,000 $200,000 - $1Million $1Million to $5Million More than $5Million
Are you a member of either of these Agency Associations?:	Big I PIA
Carrier #1*:	Top four markets in your agency:
Carrier #2*:	Top four markets in your agency:
Carrier #3:	Top four markets in your agency:
Carrier #4:	Top four markets in your agency:
Carrier #1*:	Loss ratios in the last full year with these markets:
Carrier #2*:	Loss ratios in the last full year with these markets:
Carrier #3:	Loss ratios in the last full year with these markets:
Carrier #4:	Loss ratios in the last full year with these markets:
How many standard markets do you utilize in your agency?*:
If you were referred to Indiana Farmers please share who referred you.:
Please explain briefly your interest / need in Indiana Farmers*: