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Employee Recognition
Nomination Form

Amerisure's goal is to anticipate and exceed our customers' expectations through extraordinary service. If you have received extraordinary service, and would like a chance to recognize an employee, please take a few minutes to fill in the information requested below.

Amerisure Employee's Name:
Location:
Date:
What did the employee do to provide extraordinary service?
Your Name:
Your Email:
Phone Number:
Company Name:
Relationship: Agent
Policyholder
Other (specify)