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BROKERS/AGENTS QUESTIONNAIRE

Should you be interested in an appointment with WRM America, and in order that we will be in a position to support your efforts, we would like to better define the demographics of your prospect and account base relative to the following SIC Codes:

*Indicates a required field

Name*
Title/Position*
Agency Name*
Address*
City*
State*
Zip*
E-Mail *

 
Schools
8211 - Elementary and Secondary Schools
  Premium
Revenue
# of Accounts
  8221 - Colleges and Universities
  Premium
Revenue
# of Accounts
   
Municipalities
9111 - Executive Offices
  Premium
Revenue
# of Accounts
  9121 - Legislative Bodies
  Premium
Revenue
# of Accounts
  9131 - Executive and Legislative, Combined     
  Premium
Revenue
# of Accounts
  9199 - General Government, NEC
  Premium
Revenue
# of Accounts
   
Not-for-Profit
8399 - Non Profit Organizations
  Premium
Revenue
# of Accounts



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