Agent Questionnaire

Please complete the form with as much detail as possible.

Personal Information

First Name *

Last Name *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

E-Mail Address *

Do you hold a Property and Casualty License? *

How many years have you been licensed? *

Have you ever been convicted of a felony? *

Have you ever been involved in an Errors and Omissions claim? *

Have you ever filed a Bankruptcy? *

If yes – What date was it resolved:

How many years of Property and Casualty experience do you have? *

Please explain your Property and Casualty experience: *

Please explain any other types of professional experience you may have.

Please explain why you are inquiring about the Pacific Crest opportunity. *

What percentage will P & C insurance be in your business model? *

Will you be receiving income from any other sources than P & C sales? *

If yes please explain:

Please describe what activities you will be doing to generate new business. *

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Meet Our Most Valuable Player Alex Pieters Pieters Insurance - Minden, Nevada

MINDEN, Nevada — A small community of just more than 3,000 residents east of the southern tip of Lake Tahoe, Minden, Nevada, is a quiet little town in the heart of the Carson Valley.

For just about a quarter of a century, Alex Pieters was one of a handful of police officers in the county seat of Douglas County.

Knowing the community as he does, it made sense that Alex would hang his shingle in this community that once boasted it was a getaway destination for some of the biggest names in Hollywood, including Clark Gable and Jean Harlow.

Alex understands that to succeed in a small town, being competitive with price is important.

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