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Chris-Leef Appointment Form
Please fill out the form below with as much information as possible. This form is required to complete your appointment with Chris-Leef.
Feel free to reach out to
mprendergast@chris-leef.com
with any questions.
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* Indicates required question
Email
*
Your email
First & Last Name
*
Your answer
Agency Name
*
Your answer
Accounting Rep's Name & Email Address
*
Your answer
Do you currently work with a Finance Company? If yes, which one?
*
No
Other:
Approximate amount of premium you anticipate writing with Chris-Leef in the next 12 months?
*
Your answer
What type(s) of business do you currently write? (Select all that apply)
*
Commercial Lines
Personal Lines
Professional Lines
Transportation
Other:
Required
Do you currently quote business using an online quoting system?
*
Yes
No
To which of our Online Raters would you like access? Choose all the apply:
*
Aegis
American Modern
Atlantic Casualty
Great American
RLI
USLI
Tower Hill
Hiscox Now
Required
Do you currently work with other MGA's to quote your Excess & Surplus business? If yes, who?
*
No
Other:
Send me a copy of my responses.
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