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To check account beginning with a number (i.e. 111000), click here.

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Agency Questionnaire

We greatly appreciate your interest in Skipjack PFC. So that we can learn more about your particular agency, please complete the questionnaire below.

Once submitted, a Skipjack PFC marketing representative will contact you to discuss the details of your customized premium finance program.

Contact Information:

Agency Name: *

All Risks, Ltd. Broker Code: *

Address: *

City: *

State: *

Zip Code: *

Contact Name: *

Title: *

Phone: *

Email: *

Agency Information:

Years in Business: *

Number of Employees: *

Est. Total Annual Premiums: *

Est. Total Financed Premium Volume: *

Est. Avg. Financed Premium Size: *

Premium Finance Companies Currently Using: *

E&S Wholesalers Currently Using: *

Most important factor when deciding what premium finance company your agency will work with?:

Low Rates    Ease of Use   Agency Incentives    Personal Relationship

Referred to Skipjack PFC by an All Risks, Ltd. employee? If so, please provide name(s):

Any additional comments?: