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Enroll in Business Accelerator

It’s easy. It’s free. And it’s exactly what you need to take your business to the next level.

Just complete the enrollment form and you’ll be automatically enrolled in the Business Accelerator program presented by American Family Insurance.

All fields are required.

First Name:

Last Name:

Title:

Business Name:

Address:

Address 2:

City:

State:

Zip code:

Business Phone:

Email:

Business Type:

Describe Your Business:

Business Organization Type:

Corporation / S-Corp	Partnership
LLC	Sole Proprietorship

Are you a certified minority-owned business?

Are you currently working in this business full-time or part-time?
Full-time Part-time

What was the 2008 gross revenue of your business?

What is the projected 2009 gross revenue of your business?

How many employees do you have?

How many years have you been in business?

Do you own or rent the building where your business operates?
Own Rent

Do you have company owned vehicles?
Yes No

Do you have a commercial liability policy?
Yes No

Do you currently have any insurance coverage with American Family Insurance?
Yes No

Do you plan on attending the symposium?
Yes No

If yes, which city?

How did you hear about the Business Accelerator Program?

If you selected "From someone who attended Symposium" above, from whom?

Prior to learning about the Business Accelerator Program, were you aware that American Family offers business insurance for small businesses?
Yes No Not Sure

Based on what you know today, how would you rate American Family in terms of the following?

A.) Serving the needs of the Hispanic business owner
Excellent Good Average Not so good Poor

B) Understanding the challenges and concerns of the small business owner *
Excellent Good Average Not so good Poor

C) Meeting the insurance needs of YOUR business *
Excellent Good Average Not so good Poor

How likely would you be to consider American Family Insurance for your business insurance needs if you were purchasing insurance today, or re-evaluating your business insurance needs? *
Very likely Somewhat likely Somewhat unlikely Not at all likely

Choose Password: *	6 - 12 characters
Re-type Password *

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