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Which lines of business are you interested in writing with Nationwide?


Have you been referred by a commercial submission platform system (i.e. Bold Penguin, Tarmika, etc.)?
General Agency Information
Is the Primary Contact Authorized to Sign Contracts?*
Has your agency ever applied for appointment, or been appointed by any of the Nationwide family of companies?
Agency Production
Please list your top 3 Personal Lines Carriers by total written premium:
Please list your top 3 Commercial Lines Carriers by total written premium:
What are your top 3 industries that you prospect/target and the total written premium associated with each industry?
Employee Information
Do you conduct background checks on your employees?

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