Partner Application — Purvis Agency Partner Alliance

Your Contact Information

First Name

Last Name

Email Address

Phone Number

Firm or Company Name

Question 1 of 5 What best describes your professional role?

This helps us understand how the partnership and compensation would be structured for you.

Question 2 of 5 Briefly describe your practice and the clients you serve.

Two or three sentences is plenty. What do you focus on, and who are your typical clients — individuals, business owners, or both?

Question 3 of 5 Approximately how many active clients do you currently work with?

A rough range is fine — this helps us understand the potential referral opportunity.

Question 4 of 5 When life insurance comes up in a client conversation today, what typically happens?

Choose the option that best reflects your current situation.

I refer them to someone, but the relationship isn't consistent or I'm not confident in the referral I tell the client I can't help with that and move on I handle it myself but would prefer a specialist It rarely comes up in my work There's no real process — it's handled case by case

Question 5 of 5 What would a successful referral partnership look like for you?

In your own words — what matters most to you in this kind of arrangement?

Dave reviews every application personally and will follow up to schedule a brief 30-minute call.

Your information is kept private and will only be used to contact you about the Partner Alliance program.

Tell Us a Little About Your Practice