Michael and Jamie Sanders
Agency Owners

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AustinAreaInsurance.com
P.O. Box 1997
Leander, TX 78646
(512) 259-5633
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	How did you hear about us?
	Business Name *			Partners / Owners *	- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+
	Legal Entity *	- Sole Proprietorship Partnership LLC S Corporation C Corporation Other		Full-Time Employees *	- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+
	Years in Business *	- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+		Part-Time Employees *	- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+
	Annual Revenue *	- Under $100,000 $100,000 - $500,000 $500,000 - $1,000,000 $1,000,000 - $5,000,000 $5,000,000 - $10,000,000 Over $10,000,000		Sub-Contractors *	- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50+

	4-digit SIC code corresponding the business *
	Is this a one-time or seasonal business or event *	YesNo
	Do you have any subsidiary businesses	None 1 2 3 4 5 6 7 8 9 10+

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Property / Casualty Insurance	Employee Benefits
General Liability Commercial Auto Commercial Property Professional Liability (E&O) Directors and Officers Liability Business Owners Package Policy (BOP) Workers Compensation Commercial Crime	Group Health Insurance Group Life Insurance Group Disability Insurance 401K / Retirement Plans Supplemental Plans / AFLAC Key Man Life Insurance Key Man Disability Insurance Deferred Compensation

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