Ros - People's Trust Insurance Company

Request for Binding Authority – Rest Of State

Agency Information

*Agency Name:

*PTI Agency Code:

*Agency Principal Name:

*Agency Principal Email

*Agency Address:

*Agency Principal Phone:

bindingrequire_SBP0316133

Questionnaire

*How many homeowners policies does your Agency quote per month with ALL carriers?

*How many homeowners policies do you estimate your agency will be able to sell per month through Peoples Trust?

*Which counties are you primarily writing new business in currently?

*How many CSRs/Producers does your agency have?

*How many locations do you have?

Any Additional Comments:

Contact Information – for PTI use ONLY

Once you are writing new business our Underwriting and Inspections Departments might need to be in contact your agency regarding policies you have written. In recent times we have been experiencing much longer hold times to get through to some agencies. Please provide DIRECT telephone and email contact information to assist us as fast as possible.

Underwriting Questions

*Contact Name

*Contact Email

*Contact Phone

Inspections Questions

*Contact Name

*Contact Email

*Contact Phone