CONTACT INSURANCE ASSESSMENT FORM Financial Institution Name * First Name * Last Name * Title * Address * City * State * Zip * Phone * Email * Website * Financial Institution Data (Please provide unit counts in categories where applicable.) Total Institution Assets Number of Purchase Mortgages Originated Annually Number of Residential Mortgages Serviced Number of Auto Loans Serviced Number of Business Loans Originated Annually Total Visits to Your Website Per Month Number of Retail Households Number of Refinanced Mortgages Originated Annually Number of Direct Auto Loans Originated Annually Number of Commercial Real Estate Loans Originated Annually Number of Business Loans Serviced Core Operating System and Provider Mortgage Lending - Loan Operating System Consumer Lending - Loan Operating System Privacy Notice The information you provide is confidental and will only be used for insurance sales projections. Apollo management acknowledges that this information is the sole property of the financial institution and any other use of this information is prohibited.
