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Prospect Application for Agency Appointment

Note: At this time, GAINSCO is accepting application for the states of AL, AR, AZ, FL, GA, IL, IN, NM, MO, OH, OK, SC, TX, UT, VA, and WI.

Please complete this application if you are an agent who would like to be appointed with GAINSCO Auto Insurance® and has not been contacted by a GAINSCO Territory Manager or Business Development Associate. At this time, GAINSCO is accepting prospect applications for the states of OR, PA, and MS.

  • Contact Info for Person Completing the Application

    Please tell us a little about you.
  • Agency Information

  • Type “1” if you only have one location.
  • Tell Us About Your Agency’s Business

  • GAINSCO specializes in state minimum limits personal auto insurance.
  • Please list the company name, annual volume, and years with this company.
  • Acknowledgement

    In submitting this form, I agree to opt-in to operational and marketing communications from GAINSCO Auto Insurance. This form constitutes interest only and does not guarantee appointment. In addition, you may receive a request for more information before the appointment process can begin. To acknowledge your acceptance of these terms, enter your initials and today’s date below, and click the “Submit” button to complete your prospect interest form.
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.