Complete the form below and a GAINSCO representative will call to qualify your agency
First Name *
Last Name *
Email *
Job Title *
Phone *
Which state would you like to be appointed in? * ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Do you or are you willing to write state minimum limits policies * TrueFalse
How many minimum limits policies do you write in a month? *
Does your agency use a comparative rater? * Does Not Use RaterAccuAutoApplied RaterCCi-RaterEZLynxITCQQWebRaterQuomationOtherSilver PlumeVertafore PLAZ-FSCSemcatQuick Quote (QQ)Quote RiteTru-Premium/UniCorp
How many people write personal auto in your office?
Street (Agency Address) *
Address Two
City *
State *
Zip *
Comments
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