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 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: |
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.
Product or Line |
Name: | Include In Count |
Sales Type | Include Sales Type |
Count Type | Commission Type |
Staff Assign | Threshold | Comm | Thres- hold |
>= | ADD |
Line: | Type: | CST: | Code: | Process: | From: | Tech ID: | Btn ID: | Activity ID: |
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