AGENT RESPONSE

An On-line response form designed exclusively for agents. Your input will be appreciated.

Thank you for taking a few minutes to reply to our Agent Response.  Provident American strives to be an agent supportive insurance company, and your input is extremely important to us.  Your comments and suggestions will help us to continue to offer the best service and support possible to you, our agents.
 Agent Information
 Our Statement

Name
Business Name
Mailing Address
City   State Zip 
Phone: -- Please include area code
Fax: -- Please include area code
Email
How did you learn about our web site?
Are you currently appointed with Provident American?
 YesNo
IIf you are currently appointed with us, please enter your agent number:
If you are not currently appointed with us, are you interestedin becoming an agent for Provident American? YesNo
Which best describes you:
Personal Producing General Agent (PPGA)
General Agency (GA)
Brokerage Agent
What states are you currently licensed in?
How many agents do you have working for you?
What is your primary market?
Life
Specialty Products
Senior Market
Other (specify below)
Which Provident American product(s) are you interested in?
MaiDental/Vision
ValuProtector
Accident Expense
Please use the space below for additional comments, suggestions, or questions:

Provident American is committed to providing our agents with the best service in the industry.  Quality marketing materials for our health, life and accident products, competitive rates, and outstanding agent support combine to help our agents maximize their potential for meeting their own professional goals.


 

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Not all products are available in all states where we are licensed.  Some variations may occur between the same products in different states due to state laws and requirements.  All questions regarding policy terms should be directed to a licensed Provident American agent or to our Home Office at 1-800-924-3684.  

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