Common Sense Markets
    Achieving Strength Through Unity -- Since 1990
Common Sense Markets
You may either
complete this online
eForm or you can
click here for a
printable form that
you may fax.
Underground Storage Tank (UST) Agency Profile Form

Please fill out the form below. Please provide as much information possible so that we may process your application in a timely manner. This information will be kept confidential and will be used for internal purposes only.


This Online Information Form is on a Secure Server. Click on the seal on the left for more information on the certificate's authentication.

Privacy Statement: Any information provided by a agent, prospect, or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. All submissions will be responded to within two business days.

Agency Name:  
Mailing Address:  
City:     State:   Zip:
County:     Telephone:
Fax:     Website Address:
E-mail Address:  
Tax ID:     Agency License#:
E&O Insurance Carrier:     E&O Limit:
Best Contact Time:  

Main Location (City/State):  
Satellite Offices (City/State):  
Agency location:   Single Residence   Apartment   Townhome
  Condo   Strip Mall   Multi-Unit Office
  Single Occupancy Commercial Building

Type of Ownership:   Sole Proprietorship   Partnership   Corporation   LLC
Name(s) of Owners Title Years of Experience
Years CL Experience within Agency:  
Year Agency Established:     Number of years under current Ownership:
Number of people in these Positions:  Producers/Solicitors:   CSR’s:   Other:
Check all Designations held within agency:   CPCU   CIC   AAI   CLU   ACSR   CISR
Does the agency have ownership in another agency?   No   Yes - Please provide name:
Does the agency have ownership in a captive?   No   Yes - Please provide name:
Is the agency a member of an aggregator, cluster, alliance, etc?   No   Yes - Please provide name:
Automation System(s) used:  
Agency is automated for the following function:   Bookkeeping/Rating/Management   Bookkeeping
  Rating Only

UST Carriers & Brokers:
ACE Burns & Wilcox Colony
Crum & Forster Foss Hardy Mid-Continent
Tank Owner Members Top Tanks Tudor Insurance Co.
USI Southwest Other(s)
Which Carriers(s) is most competitive?  
Top 3 UST Carriers: Written Premium PIF

Total Agency Volume:  
Percentage of Volume is:  CL:   PL:   Life/Health:   UST:
How many UST policies do you
currently have in your Agency?
Why are you looking for a new Carrier?  
What New Business commitment
can you make?
First Year PIF Second Year PIF Third Year PIF
$ $ $

Check the following that apply to your Agency:
Use Lead Generation program Use Telemarketer Have Effective Cross-sell program
Have Re-solicitation program Focused on Niche programs Actively Up-sell customers
Motivated by Contests/Incentives Sell Small Group P&C Partner with Purchasing Groups

What interests you about Common Sense Markets?
How did you hear about Common Sense Markets?
Referral         Internet         Competitor         Client         Other

Please click on the "Submit Profile" button to send your application.
One of our representatives will respond to your submission as soon as possible.



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  Anco - Common Sense Markets  
 P.O. Box 4870 
 Bryan, Texas 77805 
A division of Anco Insurance Managers, Ltd.

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