Hallmark Personal Lines New Appointment Request

Agency Name *

Agent / Owner Name

Physical Address *

Physical Address

Address

Address 2

City

State

Zip/Postal

Contact Name *

Contact Phone *

Contact Email *

SMS Opt-In

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Agency Website

# of Years in Business

Lines of Business

Auto

Renters

# of Minimum Limit Auto Policies (Per Month)

# of Renters Policies (Per Month)

Total Annual Written Premium ($)

Top Auto Carrier #1

Written Premium: ($)

Loss Ratio: (%)

Top Auto Carrier #1

Written Premium: ($)

Loss Ratio: (%)

Top Auto Carrier #1

Written Premium: ($)

Loss Ratio: (%)

Top Renters Carrier

How many policies per month could you commit to Hallmark?

How did you hear about Hallmark?

If you are human, leave this field blank.

Hallmark Personal Lines New Appointment Request

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