Matchmaker Interested Buyer

Please complete the following form. Your information will be forwarded to the seller. If the seller wants to contact you, IIAT will provide a non-disclosure agreement to complete before the seller makes contact.

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Responding to Matchmaker Profile #

This is the number located at the top of the Matchmaker email announcement

Name of Your Agency

Is your agency currently an IIAT member? YesNoNot Sure

First Name

Last Name

Email

Work Phone

Address

City

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Zip Code

Year Agency Was Established:

Agency Staff Size

Percentage of Business Placed:

% Commercial Lines

% Personal Lines

% Life & Health

Top 5 Carriers

Please list the top 5 carriers you place business with

Anything else you would like the seller to know?

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