Providing Superior Agency Management Technology

• IMS
  • IMS Product
  • Call Center Info
  • Call Center Tour
  • LinkToMyAgent Info
  • Request Demo
  • System Requirements
  • Scanner List
  • Carrier Downloads
  • Real Time
  • Electronic Signatures
  • Partners
• Training
  • Boot Camp Info
  • Boot Camp Registration
  • IMS Review
  • Phone Training
  • User Groups
  • Webinar
  • Weekly Newsletter
• User Center
  • Help Center
  • Downloads
  • New Agency
  • Update Agency
  • Submit Ideas
  • Submit Referral
  • Scanner List
  • Carrier Downloads
  • Real Time
  • Real Time Request

Submit Your Agency

Your Information

Agency Name
First Name
Last Name
Phone Number
E-mail
Website

Mailing Address

Address
City
State
Zip

Biling Information Contact (If different then above)

Different Then Above	Yes No
First Name
Last Name
Phone Number
E-mail

Office

How many locations do you have?
How many users in your office?
Have you signed up for Transformation Station?	Yes No
Would you like to sign up for Transformation Station?	Yes No
Does your office use a comparative rater, if yes which one?
What is your preferred method of contact?	E-Mail Phone Mail

List Your Users

	First	Last	E-Mail	Title	Newsletter?
01)					Yes No
02)					Yes No
03)					Yes No
04)					Yes No
05)					Yes No
06)					Yes No
07)					Yes No
08)					Yes No
09)					Yes No
10)					Yes No
11)					Yes No
12)					Yes No
13)					Yes No
14)					Yes No
15)					Yes No

List Your Carriers

	Carrier	Rep Name	Rep Phone No.	Rep E-Mail
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Other Carriers

Special Agency Information

Submit

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For More Information

If you would like to receive additional information on Insurance Management Solutions (IMS) from Xanatek, please contact the sales office toll-free at 800-875-6033 or e-mail us at sales@xanatek.com.