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Contact Information
First Name *
Last Name *
Agency Name *
Email Address *
Job Title
Department
Producer Information
Producer Name
Producer Website
Street Address
City
State
Zip Code
Work Phone
Ext
Fax Phone
Marketing/Sales
Manager's Name
Email
Operations Information
How is organization licensed? (Choose all that apply)

Other
Please confirm that you are fully licensed in all the states in which you are submittin you business.
Years in business: As an insurance agent?
Your agency?
Commission Income Breakdown
% Retail
% Wholesale Brokerage
% MGA (Binding Authority)
% Other
Personnel
Breakdown of Organization's Staff (number)
Principals / Owners
Producers (Salespeople)
Other Licensed Employees
Other Employees
Total Staff
Financial and Other Information
Internal Accounting Contact Name
Phone Number
Ext
Do you maintain Employee Dishonesty Coverage for all Officers and Employees?
Do you maintain Errors & Omission Coverage?
Limits
Have you or any officer, director or member of your organization ever had an insurance license suspended or terminated for any reason, or ever been subject to any disciplinary action?
If Yes, please explain
Is there any pending or threatened litigation or judgments within the past five years exceeding $10,000 against the broker or any principals of the organization?
If Yes, please explain
How did you hear about us
Products you are interested in selling
Agency Annual Sales
Total Premium $
Personal Lines %
Commercial Lines %
Current Carriers and Markets
Annual Premium
Personal Lines - Homeowners
1
$
2
$
3
$
Personal Lines - Dwelling
1
$
2
$
3
$
Personal Lines - Mobile Home
1
$
2
$
3
$
Commercial Lines - GL, Auto, P&C, etc.
1
$
2
$
3
$
MGA
1
$
2
$
3
$

TSGA @ A Glance

Commercial Lines Business

TSGA is a Commercial Surplus Lines MGA driven to providing a standard of excellence in products and customer service unmatched by our competitors… Learn More

Personal Lines Business

Our specialty is personal lines business and we’ve made it easy to do business with us via our internet based rating program: ISi (Internet Solutions for Insurance)… Learn More

Become a Producer

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua… Learn More

Texas Security General
Insurance Agency, LLC.

18545 Sigma Rd., Suite 101
San Antonio, Texas 78258
Phone: 210-764-1233
Toll Free 1-800-714-6789

Contact Us