Posts Tagged ‘texas insurance agent’

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Change of Address

Wednesday, May 26th, 2010

Please take a few moments to complete the following information.

All information provided is confidential and will be used solely for the purpose of processing your request.

Name
Contact Phone
Email Address
Policy Number:
Name of Insurance Company on Policy:
Change Address Information
Old Address:
New Address:
City and Zip
Phone
Questions or Comments
Online Policy Change Request Disclaimer
Requested Effective Date of Change

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Posted in Client Services | Comments Off on Change of Address

Delete Driver

Wednesday, May 26th, 2010

Please take a few moments to complete the following information.

All information provided is confidential and will be used solely for the purpose of processing your request.

Name
Contact Phone
Email Address
Address: (optional)
Policy Number:
Name of Insurance Company on Policy:
Delete Driver
First Name
Last Name
Relationship to Applicant:
Questions or Comments
Online Policy Change Request Disclaimer
Requested Effective Date of Change

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Posted in Client Services | Comments Off on Delete Driver

Add Driver

Wednesday, May 26th, 2010

Please take a few moments to complete the following information.

All information provided is confidential and will be used solely for the purpose of processing your request.

Name
Contact Phone
Email Address
Policy Number
Name of Insurance Company on Policy:
Driver Information
Name
Birth Date
Relationship to Applicant:
Gender
License #
Years Licensed:
If youthful driver, have you completed a state-approved drivers education course approved by the state
Marital Status
Job Description
Which Vehicle does the person drive?
DUI or DWI in last 6 years?
Has your license been suspended in the last 5 years?
Has your license been revoked in the last 5 years?
Do you require a SR-22?
Number of Violations in the last 5 years:
Number of Accidents in the last 5 years:
Online Policy Change Request Disclaimer
Requested Effective Date of Change

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Posted in Client Services | Comments Off on Add Driver

Delete Vehicle

Wednesday, May 26th, 2010

Please take a few moments and complete the following information.

All information provided is confidential and will be used solely for the purpose of processing your request.

Name
Contact Phone
Email Address
Address: (optional)
Policy Number:
Name of Insurance Company on Policy:
Delete Vehicle
Year
Make
Model
Vin #
Questions or Comments
Online Policy Change Request Disclaimer
Requested Effective Date of Change

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Posted in Client Services | Comments Off on Delete Vehicle

Change Vehicle

Wednesday, May 26th, 2010

Please take a few moments to complete the following information.

All information provided is confidential and will be used solely for the purpose of processing your request.

Name
Contact Phone
Email Address
Address: (optional)
Policy Number:
Name of Insurance Company on Policy:
Delete Existing Vehicle
Year
Make
Model
Vin #
Add New Vehicle
Year
Make
Model
Vin #
Estimated Annual Mileage
Vehicle Use
Miles to Work/School (1 way)
Ownership
Purchased / Leased On
Purchase Price
Primary Driver
Lienholder Name (if leased or financed)
Additional Insured
Coverages Section
Comprehensive Deductible
Collision Deductible
Questions or Comments
Online Policy Change Request Disclaimer
Requested Effective Date of Change

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Posted in Client Services | Comments Off on Change Vehicle

Change Vehicle

Wednesday, May 26th, 2010

Please complete the following information.

All information provided on this information sheet is confidential and will be used solely for the purpose of processing your request.

Contact Information

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Posted in Client Services | Comments Off on Change Vehicle

Add Vehicle

Wednesday, May 26th, 2010

Please complete the following information.

All information provided on this information sheet is confidential and will be used solely for the purpose of processing your request.

Name
Contact Phone
Email Address
Address: (optional)
Policy Number:
Name of Insurance Company on Policy:
Vehicle Information
Year
Make
Model
Vin #
Estimated Annual Mileage
Odometer Reading
Is it new or used?
Vehicle Use
Miles to Work/School (1 way)
Needs Repairs
Ownership
Purchased / Leased On
Purchase Price
Primary Driver
Who's the registered owner of the vehicle?
Lienholder Name (if leased or financed)
Lienholder Name (if leased or financed)
Additional Insured
Coverages Section
Comprehensive Deductible
Collision Deductible
Do you have Loan Gap Coverage?
Questions or Comments
Online Policy Change Request Disclaimer
Requested Effective Date of Change

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Posted in Client Services | Comments Off on Add Vehicle

Rental Property Quote

Thursday, May 20th, 2010

Personal Information

Name
Street Address
City
State
Zip Code
Phone Number
Alternate Telephone
Fax Number
Email Address
Property Information
Property Street Address
City
State
Zip Code
How many units are in the building?
How many units in the building are vacant?
Year Built
What date was the property purchased?
What is the construction type?
How many stories is it?
If two stories, what is the ground floor square footage?
What is the total square footage of the building?
What foundation type?
If structure is located in a flood zone, what is the distance to body of water?
Garage Description
What type of roof covering?
Was the roof updated?
If yes, what year?
Does the building have a pool?
If yes, is it fenced?
If there is a pool, is there a diving board?
If there is a pool, is there a slide?
Is there a smoke alarm?
Is there a fire extinguisher?
Are there deadbolts?
Is the electrical updated?
Are there circuit breakers?
Does the electrical circuit box have copper wiring?
How old is the heating/ air conditioning?
Is the heating / air conditioning thermostatically controlled?
What is the energy source?
What is the heating system?
What is the cooling system?
Has the plumbing been updated?
Is the plumbing copper?
Does the building have interior automatic fire sprinklers?
Is there a theft alarm?
Is there a fire alarm?
Are there dogs on the property?
If yes, how many and what is the breed of each dog?
Are there any other pets or animals on the property?
If yes, how many and what is the description of each?
Current Coverage Information
Current Insurance Company
Expiration Date
Were there any losses or claims in the last 5 years?
If yes, what is the date, amount paid and description of each loss or claim?
Desired Coverage Information
Dwelling Amount - Coverage A
Other Structures - Coverage B
Loss of Use - Coverage D
Premise Liability - Coverage E
Policy Deductible
Do you want building replacement cost coverage?
Best Time To Contact You
Please let us know the best time to call and discuss your quote.
Or Specify Other:

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Posted in Homeowners | Comments Off on Rental Property Quote

Commercial Property Quote

Thursday, May 20th, 2010


Please take a few moments and complete the following information.  All information provided is confidential and will be used solely for the purpose of developing your quote.

Name
Street Address
Business Name (if any)
City and Zip
Phone Number
Alternate Telephone
Fax Number
Email Address
Property Information
Property Street Address
City and Zip
How many units are in the building?
How many units in the building are vacant?
Year Built
What is tenant occupancy of the building?
What date was the property purchased?
What is the construction type?
How many stories is it?
If two stories, what is the ground floor square footage?
What is the total square footage of the building?
What foundation type?
If structure is located in a flood zone, what is the distance to body of water?
Parking Description
What type of roof covering?
Was the roof updated?
If yes, what year?
Is there a smoke alarm?
Is there a fire extinguisher?
Are there deadbolts?
Is the electrical updated?
If so, when
Are there circuit breakers?
Does the electrical circuit box have copper wiring?
How old is the heating/ air conditioning?
Is the heating / air conditioning thermostatically controlled?
What is the energy source?
What is the heating system?
What is the cooling system?
Has the plumbing been updated?
If so, when
Is the plumbing copper?
Does the building have interior automatic fire sprinklers?
Is there a theft alarm?
Is there a fire alarm?
What is left, right and rear exposures and distances?
Current Coverage Information
Current Insurance Company
Expiration Date
Were there any losses or claims in the last 5 years?
If yes, what is the date, amount paid and description of each loss or claim?
Desired Coverage Information
Dwelling Amount - Coverage A
Premise Liability - Coverage E
Policy Deductible
Do you want building replacement cost coverage?
Best Time To Contact You
Please let us know the best time to call and discuss your quote.
Or Specify Other:

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Posted in Business | Comments Off on Commercial Property Quote

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