Agency Profile 2022
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Agency Name *
Main Contact *
Main Contact Email *
Agency Years in Business *
Number of Producers *
Number of CSRs *
Estimated Total Agency Premium *
% Personal Lines *
% Commercial Lines *
Carriers Appointed Through Smart Choice (Select All That Apply) *
Required
Express Markets Carriers Appointed Through Smart Choice (Select All That Apply) *
Required
Carriers You Would Like an Appointment (Please List)
Carriers Appointed Outside of Smart Choice  *Please list and include estimated premium for each carrier* *
Is Your Agency Compliant with the Insurance Data Security Act effective July 1, 2020? *
Not familiar with this new data security act? See our blog post which includes a recording of the webinars we held. The first webinar discusses the act itself and the second covering the NODE International solution developed specifically for Smart Choice agents. https://smartchoicevirginia.com/burns-wilcox-information-security-program-webinar/ 
What Product or Services Would Help Your Agency Most Now?
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