Producer Application – Aspire General Insurance

1. Have you or your firm ever been named in any suit?*
- Yes
- No
2. Have you or your firm ever filed for bankruptcy?*
- Yes
- No
3. Have you or your firm ever been investigated by the Department of Insurance?*
- Yes
- No
4. Have you had an appointment cancelled or denied?*
- Yes
- No
5. How many years in business?*
6. Number of locations?*
7. Number of active producers?*
8. Which comparative rater(s) do you currently use?
9. What is your comparative rater customer number?
10. What agency management system do you currently use?
11. If, you use FSC, please list your Customer Number for each location.

Top Personal Auto Carriers Represented
Company Name YTD Written Premium Policies in Force Loss Ratio

Please include a copy of your agency license.
Agency Name
Address
Address City State Zip
Phone
Resident License Number
Expiration Date
MM slash DD slash YYYY
Upload Producer License(s)
Accepted file types: txt, rtf, pdf, doc, docx, xls, xlsx, Max. file size: 10 MB.
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Company Name	YTD Written Premium	Policies in Force	Loss Ratio