Now that we've had the opportunity to introduce ourselves, we'd like to learn a little about you and your company. Please take a few moments to fill out the following questionnaire:

Property/Casualty Premium Volume: $

Property/Casualty Commercial Accounts: #

Do you have a web site? Yes
No

How much do you know about captives? Nothing A little A lot

Are you already involved in captives? Yes ...What program?
No

Are you interested in having your own captive? Yes No

What lines are you most interested in? General Liability Auto Liability Products Professional Workers' Compensation Property

I would like more information on... Safety-NDG Safety/Site Inspections Reinsurance Claim Audits Consulting Services Fronting Captives Other

What about us do you want to comment on? Other:

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Business Name:
Business Address:
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Please contact me as soon as possible regarding this matter.

Contact Us...

The New Directions Group, Inc.
160 W. Foothill Parkway Suite 105-200
Corona, CA 92882
Toll Free: (866) NDG-4CAPtives
Phone: (951) 808-8428
Fax: (951) 808-8477
Email Address: allonj@newdirectionsgroup.com

Or Visit Our Other Website:

www.safety-ndg.com