Functions
Emails
Emails
| Personal Lines | |
| When will you be paying your next renewal so I know when to give you a call? | |
| Do you pay your auto insurance monthly, every six months or annually? | |
| Who do you pay your premiums to? | |
| Do you own or rent your home? | |
| Commercial Lines | |
| When will you be paying your next renewal so I know when to give you a call? | |
| Who do you pay your premiums to? | |
| Do you need a workers comp? | |
| Do you have a commercial auto policy? | |
| I'm curious, in regards to your insurance, what is most important to you? | |
| Can I send you an email with my contact information? |
Can I ask you a couple more questions and send you over a quote to look at so that you have time to think about it before paying your next renewal?
| Applicant | |||
| Name: | Gender: | ||
| Address: | DOB: | ||
| City/St Zip: | / | Email: | |
| Home Phone: | Occupation: | ||
| Cell Phone: | Marital Status: | ||
| Work Phone: | Education: | ||
| Co-Applicant | |||
| Name: | Gender: | ||
| Cell Phone: | DOB: | ||
| Work Phone: | Email: | ||
| Occupation: | Relation: | ||
| Education: | |||
| Year: | Make: |
Model: | |||
| Year Purchased: | Vehicle Use: | Damaged/Salvage Title: | |||
| VIN (0): | Titled To: | Annual/To Miles: | |||
| Driver: | Ownership: | Coverage: | |||
| Original Owner: | Rideshare: | Gap Insurance: | |||
| Expect OEM: | Is the loan balance higher than the blue book? | ||||
| Custom Equipment: | Suspension Lifted: | ||||
| Note: | |||||
| Are you open to getting more discounts by allowing a telematic device to track your driving habits? | |
| Do you have AAA? If no, would you expect your insurance to pay towing or roadside assistance expense? | |
| If your vehicle is in the body shop as a result of an accident, would you expect your insurance to pay your rental car expense? | |
| If your windshield needed to be replaced today, how much would you want to pay? | |
| If your vehicle was vandalized, you hit an animal or had hail damage how much of a deductible are you willing to pay towards those repairs? | |
| If your vehicle was damaged from a collision with another vehicle or object, how much of a deductible are you willing to pay towards those repairs? | |
| Would you be interested in going to higher deductibles to reduce premium? | |
| What's the most you'd be willing to pay? | |
| Do you have health insurance? | |
| What would best describe your financial situation? | |
| Paying your premium in full can get you a pretty big discount, so I was wondering if paying your premiums every 6 months or annually an option? | |
| Do you have an umbrella policy? |
| How does your/their name appear on your/their driver's license? | |||||
| First Name: | Last Name: | Gender: | |||
| DOB: | Drivers License: | DL State: | |||
| Relation: | Email: | Cell: | |||
| Rated Status: | DL Status: | Defensive Driver: | |||
| Education: | Student > 100 miles: | ||||
| Discounts: | |||||
| SR 22: | SR 22 Start Date: | SR 22 End Date: | |||
| Note: | |||||
| Do you own any of the following: |
| Year: | Make: | Model: | |||
| VIN (0): | Ownership: | Coverage: | |||
| CC's: | Purchase Price: | Current Value: | |||
| Custom Equipment: | Vehicle Use: | Annual Miles: | |||
| Rider: | MC Endorsement: | ||||
| Current Carrier Info | |||||
| Collision Deductible: | Comp Deductible: | Roadside Coverage: | |||
| Liability Limits: | Uninsured Liability: | UMPD: | |||
| Medical: | |||||
| Note: | |||||
| Year: | Make: | Model: | |||
| VIN (0): | Ownership: | Coverage: | |||
| Slides: | Purchase Price: | Current Value: | |||
| Custom Equipment: | Vehicle Use: | Days Used Per Year: | |||
| Original Owner | Garaging Zip Code: | ||||
| Current Carrier Info | |||||
| Current Carrier: | Premium: | Renewal: | |||
| Collision Deductible: | Comp Deductible: | Roadside Coverage: | |||
| Liability Limits: | Uninsured Liability: | UMPD: | |||
| Medical: | |||||
| Note: | |||||
| Year: | Make: | Model: | |||
| VIN (0): | Purchase Price: | Current Value: | |||
| Ownership: | Coverage: | Year Purchased: | |||
| Length: | # Of Slides: | Days Used Per Year: | |||
| Personal Property: | Want Roadside: | Rented To Others: | |||
| Current Carrier Info | |||||
| Collision Deductible: | Comp Deductible: | Roadside Coverage: | |||
| Liability Limits: | Uninsured Liability: | UMPD: | |||
| Medical: | |||||
| Note: | |||||
| Year: | Make: | Model: | |||
| VIN (0): | Ownership: | Coverage: | |||
| CC's: | Purchase Price: | Current Value: | |||
| Custom Equipment: | Vehicle Use: | Annual Miles: | |||
| Rider: | MC Endorsement: | ||||
| Current Carrier Info | |||||
| Collision Deductible: | Comp Deductible: | Roadside Coverage: | |||
| Liability Limits: | Uninsured Liability: | UMPD: | |||
| Medical: | |||||
| Note: | |||||
| Year: | Make: | Model: | |||
| VIN (0): | Ownership: | Coverage: | |||
| Length: | Hull Material: | Type: | |||
| Sub-Type: | Engine Type: | Horsepower: | |||
| Max Speed: | Fuel Type: | Education Level: | |||
| Equipment: | |||||
| Trailer Name: | Trailer VIN (0): | Trailer Value: | |||
| Current Carrier Info | |||||
| Collision Deductible: | Comp Deductible: | Hull Coverage | |||
| Liability Limits: | Uninsured Liability: | UMPD: | |||
| Medical: | Personal Property : | Roadside Coverage: | |||
| Note: | |||||
| Year: | Make: | Model: | |||
| VIN (0): | Ownership: | Coverage: | |||
| CC's: | Purchase Price: | Current Value: | |||
| Custom Equipment: | Vehicle Use: | Annual Miles: | |||
| Rider: | MC Endorsement: | ||||
| Current Carrier Info | |||||
| Collision Deductible: | Comp Deductible: | Roadside Coverage: | |||
| Liability Limits: | Uninsured Liability: | UMPD: | |||
| Medical: | |||||
| Note: | |||||
| How many properties do you insure? | |
| Property type #1: |
| Property Use: | Purchased (M/Y): | In a HOA: | |||
| Rent per month: | Months rented: | Vacant: | |||
| Dogs Count: | Breed: | ||||
| Building Information | |||||
| Address: | City/State: | / | Zip: | ||
| Year Built: | Foundation: | Pct Finished: | |||
| Stories: | Sq Feet: | Style: | |||
| Fire Hydrant: | Fire Station: | City Limits: | |||
| Exterior Information | |||||
| Roof Material: | Roof Replaced: | Impact Resistant | |||
| Roof Replacement: | Sewer Concern? | Solar Panel Cnt: | |||
| Exterior Walls: | Garage: | Garage Sizes: | Cars | ||
| Deck: | Sq Ft | Patio: | Sq Ft | Porch: | Sq Ft |
| Hot Tub: | Pool: | Trampoline: | |||
| Detached Structure: | Detached Structure: | Detached Value: | |||
| Interior Information | |||||
| Kitchen Grade: | Bathrooms: | - Full - 3/4 - 1/2 | Bath Grade: | ||
| Flooring: | Hardwood Carpet Tile Laminate Vinyl | ||||
| Fireplace: | # | Wood Stove: | Last Inspected: | ||
| Heating: | Heating Updated: | Central Air: | |||
| Plumbing: | Updated: | Wiring: | Updated: | Household Smoker: | |
| Home Features | |||||
| Dead Bolts: | Burglar Alarm: | Fire Alarm: | |||
| Protective Device: | Home Business: | Equipment Coverage: | |||
| Current Carrier Info | |||||
| Current Carrier: | Premium: | Renewal Date: | |||
| Deductible: | Deductible (Wind/Hail): | Dwelling: | |||
| Other Structure: | Personal Property: | Loss of Use: | |||
| Liability: | Medical: | Water Backup: | |||
| Losses: | |||||
| Notes: | |||||
| Purchased (M/Y): | Property Use: | HOA Insured? | |||
| Rent per month: | Months rented: | Vacant: | |||
| Dogs Count: | Breed: | ||||
| Building Information | |||||
| Address: | City/State: | / | Zip: | ||
| Year Built: | Unit Sq Ft: | Floor Located: | |||
| Kitchen Grade: | Flooring: | Hardwood Carpet Tile Laminate Vinyl | |||
| Bathrooms: | - Full - 3/4 - 1/2 | Bath Grade: | Bathroom Count: | ||
| Fireplace: | # | Wood Stove: | Last Inspected: | ||
| Heating: | Heating Updated: | Central Air: | |||
| Plumbing: | Updated: | Wiring: | Updated: | Household Smoker: | |
| Dead Bolts: | Burglar Alarm: | Fire Alarm: | |||
| Protective Device: | Home Business: | Equipment Coverage: | |||
| Current Carrier Info | |||||
| Current Carrier: | Premium: | Renewal Date: | |||
| Dwelling: | Personal Property: | Loss Assessment: | |||
| Liability: | Medical: | Loss of Use: | |||
| Deductible: | Deductible (Wind/Hail): | Loss Assessment | |||
| Losses: | |||||
| Notes: | |||||
| Purchased (M/Y): | Property Use: | In a HOA: | |||
| Rent per month: | Months rented: | Vacant: | |||
| Dogs Count: | Breed: | ||||
| Building Information | |||||
| Address: | City/State: | / | Zip: | ||
| Model Year: | Width: | Length: | |||
| Park Name: | Tied Down: | Coverage Amount: | |||
| Current Carrier Info | |||||
| Current Carrier: | Premium: | Renewal Date: | |||
| Dwelling: | Personal Property: | Loss Assessment: | |||
| Liability: | Medical: | Loss of Use: | |||
| Deductible: | Deductible (Wind/Hail): | ||||
| Losses: | |||||
| Notes: | |||||
| Purchased (M/Y): | Property Use: | ||||
| Rent per month: | Months rented: | Vacant: | |||
| Dogs Count: | Breed: | ||||
| Building Information | |||||
| Are you responsible for any of the outside structure of the property? | HOA Insured: | ||||
| Address: | City/State: | / | Zip: | ||
| Year Built: | Foundation: | Pct Finished: | |||
| Stories: | Sq Feet: | Style: | |||
| Fire Hydrant: | Fire Station: | City Limits: | |||
| End/Middle Unit: | |||||
| Interior Information | |||||
| Kitchen Grade: | Bathrooms: | - Full - 3/4 - 1/2 | Bath Grade: | ||
| Flooring: | Hardwood Carpet Tile Laminate Vinyl | ||||
| Fireplace: | # | Wood Stove: | Last Inspected: | ||
| Exterior Information | |||||
| Roof Material: | Roof Replaced: | Impact Resistant | |||
| Roof Replacement: | Sewer Concern? | Solar Panel Cnt: | |||
| Exterior Walls: | Garage: | Garage Sizes: | Cars | ||
| Deck: | Sq Ft | Patio: | Sq Ft | Porch: | Sq Ft |
| Hot Tub: | Pool: | Trampoline: | |||
| Detached Structure: | Detached Structure: | Detached Value: | |||
| Heating: | Heating Updated: | Central Air: | |||
| Plumbing: | Updated: | Wiring: | Updated: | Household Smoker: | |
| Home Features | |||||
| Dead Bolts: | Burglar Alarm: | Fire Alarm: | |||
| Protective Device: | Home Business: | Equipment Coverage: | |||
| Current Carrier Info | |||||
| Current Carrier: | Premium: | Renewal Date: | |||
| Deductible: | Deductible (Wind/Hail): | Dwelling: | |||
| Other Structure: | Personal Property: | Loss of Use: | |||
| Liability: | Medical: | Water Backup: | |||
| Loss Assessment | |||||
| Losses: | |||||
| Notes: | |||||
| Purchased (M/Y): | Property Use: | ||||
| Rent per month: | Months rented: | Vacant: | |||
| Dogs Count: | Breed: | ||||
| Building Information | |||||
| Address: | City/State: | / | Zip: | ||
| Year Built: | Foundation: | Pct Finished: | |||
| Stories: | Sq Feet: | Style: | |||
| Fire Hydrant: | Fire Station: | City Limits: | |||
| Are you responsible for any of the outside structure of the property? | HOA Insured: | ||||
| How many family units are within the property? | |||||
| Exterior Information | |||||
| Roof Material: | Roof Replaced: | Impact Resistant | |||
| Roof Replacement: | Sewer Concern? | Solar Panel Cnt: | |||
| Exterior Walls: | Garage: | Garage Sizes: | Cars | ||
| Deck: | Sq Ft | Patio: | Sq Ft | Porch: | Sq Ft |
| Hot Tub: | Pool: | Trampoline: | |||
| Detached Structure: | Detached Structure: | Detached Value: | |||
| Heating: | Heating Updated: | Central Air: | |||
| Plumbing: | Updated: | Wiring: | Updated: | Household Smoker: | |
| Interior Information | |||||
| Kitchen Grade: | Bathrooms: | - Full - 3/4 - 1/2 | Bath Grade: | ||
| Flooring: | Hardwood Carpet Tile Laminate Vinyl | ||||
| Fireplace: | # | Wood Stove: | Last Inspected: | ||
| Home Features | |||||
| Dead Bolts: | Burglar Alarm: | Fire Alarm: | |||
| Protective Device: | Home Business: | Equipment Coverage: | |||
| Current Carrier Info | |||||
| Current Carrier: | Premium: | Renewal Date: | |||
| Deductible: | Deductible (Wind/Hail): | Dwelling: | |||
| Other Structure: | Personal Property: | Loss of Use: | |||
| Liability: | Medical: | Water Backup: | |||
| Losses: | |||||
| Notes: | |||||
Do you own or rent your home?
Is your home an apartment, condo, townhouse, multi family, or single family dwelling?
| Purchased (M/Y): | Number of occupants? | In a HOA? | |||
| If less than 2 years, what was your previous address: | |||||
| Previous Address: | Previous City/State: | / | Previous Zip: | ||
| Dogs Count: | Breed: | ||||
| Building Information | |||||
| Address: | City/State: | / | Zip: | ||
| Year Built: | Foundation: | Pct Finished: | |||
| Sump Pump: | |||||
| Stories: | Sq Feet: | Style: | |||
| Fire Hydrant: | Fire Station: | City Limits: | |||
| Exterior Information | |||||
| Roof Material: | Roof Replaced: | Impact Resistant | |||
| Roof Replacement: | Sewer Concern? | Solar Panel Cnt: | |||
| Exterior Walls: | Garage: | Garage Sizes: | Cars | ||
| Deck: | Sq Ft | Patio: | Sq Ft | Porch: | Sq Ft |
| Hot Tub: | Pool: | Trampoline: | |||
| Detached Structure: | Detached Structure: | Detached Value: | |||
| Interior Information | |||||
| Kitchen Grade: | Bathrooms: | - Full - 3/4 - 1/2 | Bath Grade: | ||
| Flooring: | Hardwood Carpet Tile Laminate Vinyl | ||||
| Fireplace: | # | Wood Stove: | Last Inspected: | ||
| Heating: | Heating Updated: | Central Air: | |||
| Plumbing: | Updated: | Wiring: | Updated: | Household Smoker: | |
| Home Features | |||||
| Dead Bolts: | Burglar Alarm: | Fire Alarm: | |||
| Protective Device: | Home Business: | Equipment Coverage: | |||
| Floaters: | $ Jewelry $ Firearms $ Collectibles | ||||
| Do you plan to buy a new home or refinance in the near future? | What year? | ||||
| Losses: | |||||
| Notes: | |||||
| Move In Date (M/Y): | Number of occupants? | ||||
| If less than 2 years, what was your previous address: | |||||
| Previous Address: | Previous City/State: | / | Previous Zip: | ||
| Dogs Count: | Breed: | ||||
| Building Information | |||||
| Address: | City/State: | / | Zip: | ||
| Personal Property | Unit Sq Ft: | Year Built: | |||
| Floaters: | $ Jewelry $ Firearms $ Collectibles | ||||
| Do you plan to buy a new home or refinance in the near future? | What year? | ||||
| Notes: | |||||
| Current Auto Coverage: | |||||
| Carrier: | How Long: | Premium: | |||
| Renewal: | Renewal Cycle: | Pay In Full: | |||
| Limits: | / | Uninsured: | Medical: | ||
| Note: |
| Current Homeowners Coverage: | |||||
| Carrier: | Premium: | Renewal: | |||
| Dwelling: | Other Structure: | Personal Property: | |||
| Liability: | Medical: | Loss Of Use: | |||
| Deductible: | Deductible (Wind/Hail): | How Is It Paid: | |||
| Water Backup: | Replacement Cost: | Extended Dwelling: | |||
| Floaters: | $ Jewelry $ Firearms $ Collectibles | ||||
| Note: |
| Current Renters Coverage: | |||||
| Do you have renters insurance? | |||||
| Carrier: | Deductible: | Renewal: | |||
| Personal Property: | Liability: | ||||
| Premium: | How Is It Paid: | ||||
| Floaters: | $ Jewelry $ Firearms $ Collectibles | ||||
| Note: |
| Do you pay a life insurance premium or have life insurance through your employer? | |
| Would you like me to review that part of your insurance as well? | |
| What would you want life insurance to do for you? | |
| What's the balance of mortgage or how much would you need to buy house? | |
| How much is your mortgage or rent payment? | |
| Do you use tobacco in any form? | |
| Have you ever submitted a claim thinking something was covered, only to find out it wasn't? | |
| On a scale from 1 to 10, ten being very knowledgeable. What number would you use to rate your understanding of insurance and how to best use it to protect yourself? | |
| Do you prefer having an agent looking out for your best interest or do you prefer doing things yourself? | |
| Do you own a business? |
| Umbrella | ||
| Amount | Current Carrier | Premium |
| Name: | Gender: | ||
| Resident Address: | DOB: | ||
| City/St Zip: | / | Work Phone: | |
| Cell Phone: | Home Phone: |
| Year: | Make: | Model: | |||
| Personal Use: | Cost New: | Annual Miles: | |||
| VIN (0): | Ownership: | Coverage: | |||
| Vehicle Category: | Hitch Type: | Radius (One Way): | |||
| Gross Weight: | Driver: | ||||
| Attached Equipment: | Loan > blue book? | Gap Insurance: | |||
| Note: | |||||
| Are you open to getting more discounts by allowing a telematic device to track your driving habits? | |
| If your vehicle is in the body shop as a result of an accident, would you expect your insurance to pay your rental car expense? | |
| If your windshield needed to be replaced today, how much would you want to pay? | |
| If your vehicle was vandalized or you hit an animal how much are you willing to pay towards your repairs? | |
| If your vehicle was damaged from a collision with another vehicle or object, how much would you want to pay towards repairs? | |
| What's the most you could afford to pay? | |
| Business name? | |
| Type of business? | |
| How is the business structured? | |
| What is the name of the owner, CEO or president? | |
| Owner, CEO or president DOB? | |
| Do you have a USDOT number? | |
| If no, do you plan to obtain a USDOT number in the next 60 days? | |
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Companies will likely have a USDOT Number if any of the following apply:
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| Do you have a General Liability or Business Owner Policy? | |
| What year did the business begin? | |
| EIN? | |
| How much liability coverage do you need? | |
| Do you have a commercial umbrella policy? |
| How does your/their name appear on your/their driver's license? | |||||
| First Name: | Last Name: | Gender: | |||
| Rated: | DOB: | Drivers License: | |||
| Relation: | Defensive Driver: | SR 22: | |||
| Current Commercial Auto Coverage: | |||||
| Carrier: | How Long: | Premium: | |||
| Renewal: | Renewal Cycle: | ||||
| Limits: | / | Uninsured: | Medical: | ||
| Note: |
| Current General Liability Coverage: | |||
| Current Insurance Carrier: | Current liability limits: | ||
| Current premium: | Current renewal date: | ||
| Number of claims in the last 5 years: | |||
| Current Workers Comp Coverage: | |||
| Current Insurance Carrier: | Current annual payroll: | ||
| Current premium: | Current renewal date: | ||
| Number of claims in the last 5 years: | |||
| Name: | Gender: | ||
| Resident Address: | DOB: | ||
| City/St Zip: | / | Work Phone: | |
| Cell Phone: | Home Phone: |
| About Location | |
| Business name? | |
| Is your business address different than your residential address? | |
| Business physical address? | |
| Business physical city, st, zip? | |
| Do you lease or own your business location? | |
| Business mailing address? | |
| Business mailing city, st, zip? | |
| About Business | |
| Description: | |
| Type of business? | |
| How is the business structured? | |
| Years of industry experiences: | |
| What year did the business begin? | |
| Are you the owner, CEO or president? | |
| Who is the owner? | |
| Owner, CEO or president DOB: | |
| EIN: | |
| Business website: | |
| Business Sales & Payroll | |
| Number of full time employees: | |
| Number of part time employees: | |
| Do you use sub-contractors? | |
| Annual sales: | |
| Annual payroll (not including sub-contractors, clerical, or owner): | |
| Annual clerical payroll: | |
| What percent of annual sales is paid to sub-contractors: | |
| Building Information | |
| Building construction type: | |
| Total square footage of building: | |
| Total square footage occupied: | |
| Year built: | |
| Number of stories: | |
| Roof replaced: | |
| 100% sprinklered: | |
| Do you have a central station alarm (3rd party company): | |
| Additional Information | |
| How much business property coverage do you need? | |
| How much tool coverage do you need? | |
| How much equipment coverage do you need? | |
| Do you do anything with new construction or track homes? | |
| How much liability coverage do you need? | |
| Current General Liability Carrier: | |
| Number of claims in the last 5 years: | |
| Do you need a workers compensation policy? | |
| Do you have a commercial umbrella policy? | |
A basic businessowners policy typically includes three or four key coverages:
Additional BOP coverage options include:
When considering a BOP, keep in mind that it often makes sense to choose overage specific to your industry and that some coverages aren't available in a BOP, such as business auto, workers' compensation, and employee benefits.
You might have additional insurance needs that arent covered by general liability insurance. There are many other products available to protect your business. Here’s a short list:
| Vehicle | Comprehensive | Collision | Glass | Rental | Roadside | UMPD | Rideshare | Custom Equipment |
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| Motorcyle | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Year: | Make: | Model: | |||
| VIN ( 0):: | Ownership: | Coverage: | |||
| CC's: | Purchase Price: | Current Value: | |||
| Custom Equipment: | Vehicle Use: | Annual Miles: | |||
| Rider: | MC Endorsement: | ||||
| Current Carrier Info | |||||
| Renewal Date: | Premium: | ||||
| Comp Deductible: | Collision Deductible: | Roadside Coverage: | |||
| Liability Limits: | Uninsured Liability: | UMPD: | |||
| Medical: | Custom Equipment: | ||||
| Note: | |||||
| Motorcyle | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Motorcyle | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Trailer | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Trailer | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Boat | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Jet Ski | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Golf Cart | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Snow Mobile | Comprehensive | Collision | Rental | Roadside | UMPD | Custom Equipment |
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| Vehicle | Comprehensive | Collision | Glass | Rental | Roadside | UMPD | Rideshare | Custom Equipment |
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| Date | Driver | Description | PD Amount | BI Amount | Collision Amount |
MP Amount | Vehicle Involved |
| Date | Driver | Description |
| Date | Driver | Description | Amount | Vehicle |
| First Name: | DOB: | Gender: | |||
| Spouse Name: | DOB: | Gender: | |||
| Do you own or rent? | |||||
| What is your mortgage payment per month? | |||||
| What is the balance of your primary mortgage? | |||||
| Do you have a second mortgage? | |||||
| What is the balance of your second mortgage? | |||||
| Second mortgage payment? | |||||
| How much rent do you pay per month? | |||||
| If you needed to pay off all your debt today (not including your home) how much would you need (car loans, credit cards, student loans, rental property, etc)? | |||||
| Approximately, how much do you pay on this debt per month? | |||||
| How many kids do you have that are under the age of 18? | |||||
| What is the age of your youngest child? | |||||
| What would _______ expect to receive from life insurance benefits currently in force if something were to happen to _______? | |||||
| What would _______ expect to receive from life insurance benefits currently in force if something were to happen to _______? | |||||
| What is _______'s monthly earned income? | |||||
| Is _______'s income full-time or part-time? | |||||
| If _______ is a homemaker, currently not working, or income is part-time, how much would you expect to earn if working full-time today? | |||||
| What is _______'s monthly earned income? | |||||
| Is _______'s income full-time or part-time? | |||||
| If _______ is a homemaker, currently not working, or income is part-time, how much would you expect to earn if working full-time today? | |||||
| Do you have any other source of income, such as a pension, rental property, trust, etc, that you are currently receiving monthly? | |||||
| How much do you receive each month? | |||||
| How much of this additional income would _______ continue to receive in the event of _______ death? | |||||
| How much of this additional income would _______ continue to receive in the event of _______ death? | |||||
| Is _______ a tobacco users? | |||||
| Is _______ a tobacco users? | |||||
| Social Security Benefits Calculator: | |||||
| _______'s Survivor Benefits Your Child/Spouse Caring For Your Child | |||||
| _______'s Family Maximum | |||||
| _______'s Your Spouse At Normal Retirement Age | |||||
| _______'s Survivor Benefits Your Child/Spouse Caring For Your Child | |||||
| _______'s Family Maximum | |||||
| _______'s Your Spouse At Normal Retirement Age | |||||
| Social Security Benefit Calculator | |||||
All imported records can be accessed by agent. However, if you want a staff person to have access to imported records, you must login in under that staff person and then import records. If you need help, please call 303-986-5458.
Step 1: Click browse button to select file to upload. It must be a .csv file.
Step 2: Click the upload file button.
Step 3: Set System For IPA's fields to align with the uploaded data fields. Leave System For IPA's fields set to *** Select Field *** if you don't need to import a particular piece of data from uploaded file.
Step 4: Click the preview button.
Step 5: Review the preview data to assure everything looks right.
Step 6: Click the red Upload Records button.
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