Become a Genesee Contracted Agent

We welcome the opportunity for you to consider becoming an agent for Genesee General. At Genesee, we offer competitive products and services for a variety of binding and brokerage classes for: Commercial Property and Casualty, Umbrella, Liquor Liability, Pollution, Transportation, Garage, Professional liability, Difficult to Place Property, Coastal Wind and Inland Risks.

For consideration to become an agent with Genesee, please review and complete the following Producer Information Form. We look forward to becoming your #1 choice for all your Commercial Needs.

Producer Information
*FIRM NAME:
*CONTACT NAME/TITLE:
ADDRESS:	Street:
	City: State: Zip: Alabama Colorado Florida Georgia South Carolina Tennessee Other
*EMAIL:
*YEARS IN BUSINESS:
*PHONE #:
FAX #:
	Ownership of Firm: Title: Ownership %: Lic#:
HOW DID YOU HEAR ABOUT US:
DOES YOUR AGENCY HAVE A NICHE OR FOCUS:
Policy
ERRORS & OMISSIONS CARRIER:
POLICY #:
EXP. DATE:
LIST WHOLESALE BROKERS WITH WHOM YOU DO BUSINESS:
Additional Information
WHAT IS YOUR PERCENTAGE OF:	Commercial Lines: Personal Lines:
ESTIMATED ANNUAL PREMIUM:	Commercial Lines: Premium Lines:
Route To
*OFFICE LOCATION:	Select an Office CO, UT, WY, NM AL, SC, TN GA, FL Other