Ashley General Agency

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2040 N Loop 336 W
Suite 200
Conroe, TX 77304
Phone: 
Toll Free: 
Fax: 
(936) 441-5959
(877) 633-5959
(936) 521-5922
Exceeding your expectations, a Texas INDEPENDENT...
Ashley General Agency
 
Ashley General Agency
 

Producer Profile


Please provide as much information possible on this application. This information will be kept confidential and will be used for internal purposes only.

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Privacy Statement: Any information provided by a consumer 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
Street or P.O. Box:  
City:     State:   Zip:
Physical Address (if different from above)
Street:  
City:     State:   Zip:
Phone:     Fax:
Email Address:  
Web Address:  
Tax ID or SS#:     You Are:

LIST YOUR TOP 5 COMPANIES AND MGAs/SURPLUS LINES BROKERS
Companies
MGA/Surplus Lines Brokers
1.
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What percentage of these lines of business is your Agency currently writing:   % Commercial 
 % Personal 
 % Other 
Agency volume for the past 3 years beginning with the most recent year: 
Last Year
  
2 years ago
  
3 years ago
  
 $
  
 $
  
 $
  
Of the above listed volume - what % is Commercial E&S or Surplus Lines Business?:   %
Number of years in business:    years
Name Of E&O Carrier:   
Limits:   
Expiration Date:   

PLEASE LIST THE KEY PERSONNEL IN YOUR OFFICE INCLUDING,
OWNERS, CEO, ACCOUNTING, MARKETING,CSRs & ADMINISTRATION
 
Name
Title
Email
Phone Extension
1.
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8.

 
POLICIES, ENDORSEMENTS, and MISCELLANEOUS Documents
Will you accept policies, endorsements, and miscellaneous
documents via email?:
Yes  No
If "Yes", please list (below) a general email box or a specific
person you would like such documents to be directed to:

 
PLEASE LIST (in order of importance) THE TYPES OF RISKS YOU SPECIALIZE IN:
  1.   2.   3.
  4.   5.   6.
  7.   8.   9.

Form Completed By:  
Referred By:  
Additional Comments:  

PLEASE FAX OR EMAIL YOUR E&O DEC PAGE AND LICENSE TO Ashley General Agency

Fax: (936) 521-5922         Email: hnelson@ashleyga.com

THANK YOU!!!

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Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.
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