Prospective Agency Questionnaire

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Prospective Agency Questionnaire

Thank you for applying for an agency appointment with Tower Hill Insurance Group. The Tower Hill Family of Companies specializes in property insurance for both personal lines and commercial lines.

Tower Hill Insurance has been offering competitive products exclusively through our agency partnerships since 1972. Tower Hill is headquartered in Gainesville, Florida and also has offices in the following locations: in Palm Beach, Florida; Lexington, Kentucky; Loveland, Ohio; and Dallas, Texas.

Currently, Tower Hill writes business in these states: Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Illinois, Louisiana, Michigan, Mississippi, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Wisconsin.

If you are interested in representing Tower Hill Insurance, please complete this prospective agency questionnaire (PAQ). Please note that product availability is currently limited in some states.

For what type of agency are you applying?*

Independent Agency

Captive Agency

For what line(s) of business are you applying?*

Personal Lines

Commercial Lines

In which state(s) are you looking to write business?*

Alabama

Arizona

Arkansas

Florida

Georgia

Illinois

Indiana

Louisiana

Michigan

Mississippi

Missouri

North Carolina

Ohio

Pennsylvania

South Carolina

Tennessee

Texas

Wisconsin

In which state(s) are you looking to write business?*

Alabama

Florida

South Carolina

Texas

Hidden

THIG Personal Lines Lead

Yes

Hidden

THIG Commercial Lines Lead

Yes

Hidden

Tower Hill Specialty Lead

Yes

Do you have a physical location in Florida?*

Yes

Agencies seeking an appointment to write business in Florida must have a physical location in the state.

General Agency Information

Agency Name: (as indicated on W9)

DBA Name

The agency name you provide here will be printed on all policy documents and used in Tower Hill marketing materials and channels, such as the Agency Search feature on Tower Hill's website.

Location Address

Street Address City State ZIP Code

Agency Phone Number

Tax or Federal ID

Current # of Employees

Agency Website URL

Agency Facebook URL

Agency Twitter URL

Agency E-Mail Address

Year Established

Do you have a current Personal Lines appointment with Tower Hill?

Yes

Do you have a current Commercial Lines appointment with Tower Hill?

Yes

What is your Tower Hill agency number?

Has the agency had a prior appointment with Tower Hill Insurance Group?

Yes

Are you a sub-producer of a Managing General Agency (Wholesaler)?

Yes

What is the name of the MGA?

Has any company terminated the agency within the past three years?

Yes

If YES, please explain in detail in the space provided below.

Ownership of Book?

Agency

Producer

Combination

Other

Are you buying a current Tower Hill book of business?

Yes

Please provide the name of the agency from whom you are buying the book of business.

If available, please provide the Tower Hill agency number (e.g., FL1234) for the agency from whom you are buying the book of business.

If available, please upload a copy of your buy/sell agreement.

Max. file size: 80 MB.

Has the agency or any officer, owner, or partner ever been charged, arrested, or convicted of a felony?

Yes