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1. Please enter your contact information.
First Name :
Last Name :
Phone :
Email Address :
 
 
2.  
Do you believe you are receiving 100% of your commissions and all carrier payments are accurate?
 
No
 
Yes
 
 
3.  
How do you currently track your commissions?
 
I don't
 
Excel
 
Manual/Hand
 
Other
    
 
 
4.  
How many active policies make up your block of business including medical, ancillary, life and property/casualty?
   
 
 
5. How satisfied are you/company with the following:
Very UnsatisfiedUnsatisfiedNeutralSatisfiedVery Satisfied
Ability to Track Commissions
Organization of Receivables
Peace of Mind
 
 
6.  
Would you be interested in a complete commission tracking service that will manage, track, follow-up with carriers and recover your missing commissions for you as well as receive automated reports?
 
Yes
 
No