• Find out if you're eligible!
  •  No obligation
  •  Quick and easy
  • Step 1: Complete Questionnaire
  •  Step 2: NDA + Background Authorization
  •  Quick review + response time
Start The Questionnaire Here:
Please confirm that you meet our 3 basic qualifications:
  •  Yes, I operate in one of these 29 states: AR (central and west only), AZ, CO (excluding the Front Range), GA (100 mile coastal restriction), IA, ID, IL, IN, KS (Kansas City area only), MN, MO, MS (100 mile coastal restriction), MT, NC (100 mile coastal restriction), ND, NE, NM, NV (excluding Las Vegas), NY (100 mile coastal restriction), OH, OR, PA (excluding Philadelphia), SD, TN (central and east only), UT, VA (100 mile coastal restriction), WA, WI or WY.
  •  Yes, I have 2+ years' experience selling Property & Casualty.
  •  Yes, I will be selling Property & Casulaty full-time.
Just to clarify who we do not work with:
  •  Agents who do not intend to earn direct appointments with our network of carriers.
  •  Life and Health agencies that want to add Property and Casualty to their lineup.
  •  Captive agents who want to contract their spouse.
  •  Non-standard agencies looking for access to “preferred” carriers.
  •  Agents that have a recent bankruptcy or very poor credit rating.
First Name:
Last Name:
Phone Number:
Agency Mailing Address:
Which best describes your Current Background?
Years of P&C Sales Experience:
Number of Licensed Producers in the Agency:
Number of Licensed CSRs in the Agency:
Are you willing to get a Business Location if a carrier requires it for a Direct Appointment?
Insurance Experience: Company Names, Dates, Position, Termination Reason
Please complete the following information for the P&C carriers you currently represent or most recently represented; Company, Total Premium, Loss Ratio:
Please list current or previous affiliations with any other networks:
What is your agency's total written premium volume?
What is your percentage of Personal Lines vs Commercial Lines?
What is your percentage of Property & Casualty vs Life & Health business?
How many quotes are you running per month?
Where do you currently get leads from?
What is your marketing strategy and who are you targeting?
Please provide a percentage breakdown of the limits your agency writes (Percentage of customers at 25/50 or lower vs. 50/100 vs. 100/300+):
Have you ever been a party to a legal proceeding involving any insurance company, agency or DOI?
Have you ever been terminated by an insurance company for any reason?
Do you have any outstanding amounts owed or due to insurance companies?
Have you ever been convicted of a crime?
Have you ever had a major driving violation?
Have you ever filed for bankruptcy?
Do you have any past due amounts on your credit history or items in collection?
Are you affiliated with any captive entity or carrier?
Are you currently party to a non-compete agreement?
If you answered Yes to any of the above, please explain:
How did you hear about IPA?
What is your target start date?
Please list any additional comments or questions below:
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