OUR SUBMISSION PROCESS

Use the form on this page to fill out your information and to share your interest in becoming an affiliate partner for LOOP.

Submit your information using this form.

Once you submit your information, we will review your submission. We may reach out for additional information and/or to meet you.

After careful review, we will provide details of your unique partnership contract, affiliate link, and media kit to begin promoting LOOP to your community.

Welcome to the LOOP Affiliate Partnership Program!

We're excited to explore a potential partnership with your brand. This form will help us understand more about your business.

Start
Takes 5 minutes

First Name

Last Name

Insurance Discipline

• Actuary
• C-Suite
• Claims
• Customer Service
• Data
• Engineering
• Independent Agent
• Marketing
• Reinsurance
• Product
• Sales
• Underwriting
• Other

Email

LinkedIn URL

Thank you for your submission. We will be in touch via email.

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BECOME A PARTNER AGENT

Principal Legal First Name

Principal Legal Last Name

Principal Email Address

Phone Number

Agency Type

• Independent Agency
• Market Access Provider
• Independent Sole Proprietor
• Wholesaler
• Aggregator
• MGA
• Other

Agency Name

Agency Website

Where is your agency based?

Principal Agent National Producer Number

When was your agency founded?

What is your agency's annual Gross Written Premium?
Select your range...

• $100,000 - $499,999
• $500,000 - $999,999
• $1,000,000 - $2,999,999
• $3,000,000 - $4,999,999
• $5,000,000 - $9,999,999
• $10,000,000 - $14,999,999
• $15,000,000+

What percentage is Private Passenger Auto?

How many employees does your agency have?

• 1-4
• 5-9
• 10-20
• 21+

How many Carrier appointments does your agency have?

• 1-4
• 5-9
• 10-20
• 21+

States Licensed to Sell

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• 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

Agency Management System

• Better Agency
• Ez Lynx
• Hawksoft
• QQ Catalyst
• Other

Comparative Rater

• Ez Lynx
• I'm not using one
• Other

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