Commercial Excess Automobile Liability Producer Questionnaire

Agency Name

Address

City

State

Zip

Contact Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Agency is primarily:

Wholesale

Retail

Combination

Do you hold an active Excess and Surplus lines license?

Yes

List all states in which you’re currently licensed to do E&S business:

Premium currently written in Commercial Excess Automobile Liability:

Please provide a brief summary of your Agency’s portfolio in Commercial Automobile and Excess Automobile Liability.

For more information, please contact us today at 516-431-4441 x3203 or excesscal@lancerinsurance.com.