Let's Work Together!

EBS is seeking to develop partnerships with successful insurance agents who are in the group health/employee benefits business on a full-time basis, and plan on continuing in that business for the foreseeable future.

This questionnaire is designed to assist both you (the insurance professional) and EBS in determining whether a mutually beneficial relationship can develop. Please complete and submit the EBS Prospective Agent Questionnaire and an EBS team member will contact you shortly.

Please call us with any questions at 601.353.0002 or email us at proposals@ebs17.curleydesign.com.

Please complete the following information:

Name

Email

Street

City

State

Zip

Phone

Fax

*Required field

Current

*Required field

Future

The remaining questions will help EBS gain a better understanding of how we can provide value to our agent partners. This information is vital as we develop new products and services.

6. As you think about the next three (3) years, what are the major accomplishments that need to take place in order for you to feel satisfied with your progress?

a.

b.

c.

d.

7. What are the key challenges or dangers that you are currently facing?

a.

b.

c.

d.

8. What are major opportunities currently available to you?

a.

b.

c.

d.

9. What are the major advantages or strengths that you currently enjoy?

a.

b.

c.

d.