866.574.0008
9100 Southwest Freeway, Suite 201, Houston, Texas 77074
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Step
1
of 4
General Information
Have you already seen an Aspire demo?
*
Yes
No
Contact Name
*
Name of Agency/Company
*
Main Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mailing Address (if different from above)
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Telephone
*
Fax
Email
*
Website/URL
We cater to (check all that apply)
*
Personal Lines
Commercial Lines
Life/Health
What type of agency management software are you currently using?
*
Will you require data migration from your current system?
*
Yes
No
Will your agency require carrier downloads?
*
Yes
No
Do you currently subscribe to comparative rater?
*
Yes
No
What do you like about your current system?
What do you dislike about your current system?
What you seen or heard about Aspire that intrigued you?
How did you hear about Aspire?
Google
Bing
Yahoo
MSN
Other Search Engine
Internet Banner
Facebook
Twitter
Linked In
Marketing Email
Convention/Conference
Impowersoft Employee
Current Customer
Friend
Business Associate
Competitor
News Story
TV
Radio
Other
Next
BACKGROUND
Multiple locations?
*
Yes
No
Preferred Contact Method
*
Email
Phone
No Preference
Does your agency specialize in any particular line of insurance?
*
Yes
No
Next
PERSONNEL (total all locations, if applicable)
Type #
Number of Owners
*
Number of Managers
*
Number of Producers
*
Number of CSRs
*
Number of Administrative Employees
*
Total Number of Employees
*
Next
OPERATIONS
book of business make up pecentage(%)
Commercial Auto
*
Personal Auto
*
Commercial Lines
*
Homeowners/Renters
*
Life
*
Health
*
All Other Lines
Total All Lines
*
Should total 100%
Top 5 Carriers/MGAs Represented
*
Separate with commas
Message
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