Become an Insurance Agent with The Hartford

PRE-SCREENING QUESTIONNAIRE

Thanks for your interest in becoming an agent with The Hartford. We need to get some information from you to get the process started. All answers are required unless they are marked as "optional."


GENERAL INFORMATION

First, please share some basic information about your agency.


AGENCY INFORMATION

Next, answer some questions about your agency’s business.

Has your agency ever applied for appointment or been appointed by The Hartford?
Does your agency currently have premium placed with The Hartford through another agency, broker or aggregator?
Do you conduct background checks on your employees?

PREMIUM INFORMATION

Now, share some information about your agency's premium amounts.

$
%
%

Now we’ll ask for your top three insurance carriers by total written premium volume. This question is for both Commercial and Personal lines, so you’ll list six carriers in all. We’ll also ask for your new monthly quote flow volume and issue rate information.

$
$
$

$
$
$

SIGNATURE AND CERTIFICATION

Finally, we’ll ask you to sign the form, certifying that the information you just provided is correct. You’ll have a chance to share any comments or questions at the end of the form, before you submit.

By my signature below, I certify that the information I just provided in this form is complete and accurate. If an appointment is offered to me and my agency, I understand that a background check may be conducted on me and all my staff members as part of the appointment process.