Contact Person: 

Agency Name (required): 

Street Address: 

City (required): 

State:    ZIP: 

Phone (required):    Fax: 

Agency Email Address: 

Select the Auto companies you represent.  To select multiple companies, hold down the Ctrl key as you click.

AAA** Affirmative Insurance Company of Michigan AIG Allied PC American Fellowship AutoOwners* Bristol West (Reliance) CHUBB Cincinnati* Citizens Dairyland Employers / Hamilton Mutual Encompass (CNA) Fireman's Fund Founders Frankenmuth Fremont General Accident GMAC (Integon) Grange Great Lakes Hartford Hastings Mutual Infinity Property & Casualty (Great American) Lake States / Harleysville Leader National Merchants Mutual Mercury Insurance Michigan Automobile Placement Facility (MAIPF) Michigan Insurance Company Michigan Millers Mutual Services Casualty Insurance (MSCI / MIC) Northern Mutual Northpointe Ohio Casualty / West American OMNI Partners Insurance Pioneer Progressive* Safeco Secura Southern Michigan State Auto Titan Titan Affinity Travelers Westfield / Ohio Farmers / American Select Wolverine Mutual

Select the Home companies you represent.  To select multiple companies, hold down the Ctrl key as you click.

AAA** Allied PC American Fellowship AutoOwners / Homeowners (HOIC)* Badger Mutual Brotherhood Mutual Chubb / Great Northern / Federal Pacific Indemnity Cincinnati Citizens Employers Encompass (CNA) Farmers / CIVIC P&C* Farmers and Merchants* Farmers Mutual Fireman's Fund Foremost Frankenmuth Fremont Mutual Grange Hartford Hastings Mutual Infinity Property & Casualty (Great American) Lake States / Harleysville Merchants Mutual Michigan Basic Property (MBPIA) Michigan Insurance Company Michigan Millers Northern Mutual Ohio Casualty / West American / American Fire Partners Insurance Pioneer State Mutual Safeco Secura State Auto Travelers / AETNA Westfield / Ohio Farmers / American Select Wolverine

Select the Fire companies you represent.  To select multiple companies, hold down the Ctrl key as you click.

AutoOwners* Citizens Farmers & Merchants* Fremont Mutual Hastings Mutual Michigan Basic Property (MBPIA) Michigan Insurance Company Northern Pioneer State Mutual Wolverine

Agency Management System (if any):    Version: 

Current Pricing Software:    Annual Cost: 

Please send the demo software:  on CD   via Internet.