Become an Insurance Agent With The Hartford

Small Commercial Pre-Screening Questionnaire

Please fill out the application below for a Small Commercial agency appointment. If you are interested in a different line of business, you can download forms for Personal Auto and Home or for Middle Market, Large Commercial and Specialty.

Información general

Please share some basic information about your agency.

Agency Information

Answer some questions about your agency’s business.

Is your agency currently a member of an aggregator?

Agency Volume

Share some information about your agency's book of business.

$
%
%

List your top three Commercial Lines carriers and total written premium for each. Please put N/A where appropriate.

$
$
$

Agency Demographic Information

The Hartford's commitment to Diversity, Equity and Inclusion is one of our top priorities. Increasing our commitment starts with understanding more about our Agency demographic information. We invite you to provide us with your gender, race and ethnicity so that we understand more about your identity and drive towards inclusive outcomes.

Signature and Certification

Please sign the form certifying the information you provided is correct. Please share any additional information or questions in the comments.

By my signature below, I certify that the information I just provided in this form is complete and accurate. If an appointment is offered to me and my agency, I understand that a background check may be conducted on me and all my staff members as part of the appointment process.