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First name
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Last Name
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E-mail Address
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Job Title
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Company
*
Phone
*
(xxx-xxx-xxxx)
Fax (xxx-xxx-xxxx)
What best describes your company
*
Please choose one
Aggregator
Captive
Carrier
Excess & Surplus Lines Broker
General Agency
General Agency and Carrier
General Agency and Excess & Surplus Lines Broker
Managing General Agency
Managing General Agency and Carrier
Managing General Agency and Excess & Surplus Lines Broker
Managing General Underwriter
Managing General Underwriter and Carrier
Managing General Underwriter and Excess & Surplus Lines Broker
Master Policy Holder and Administrator
Program Administrator
Risk Purchasing Group
Risk Retention Group
Insurance Industry Service Provider
Wholesale Broker
How many states do you write business in?
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One State
1-5 States
1 or More Regions
National
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Message
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Target Audience
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Property & Casualty
Life & Health (Life/Health/LTC/DI)
Employee Benefits
Financial Services (Variable/Indexed)
What marketing do you do?
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Email Marketing
Print Advertising
Search Engine Optimization
Social Media Marketing
We Do It In House
We Use Outside Marketing Companies
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