Auto Quote Questionnaire

How do you spell your first name?

How do you spell your last name?

First Name

Last Name

What is the Street Address of where you live?

Street *

123 Fake St

City *

State *

Zip *

How long have you lived at your current address?

How long have you lived there?

Length at current address

Since you've lived there less than a year, what was your previous address?

Street

Street Address Line 2

City State

Zip

Is your mailing address different from the garaging address?

Mailing address

Street

Street Address Line 2

City State

Zip

What is your cell phone number?

Cell number ONLY in this section

Do you have any alternate numbers?

Alternate phone number type

Alternate phone number

And so that I can email you the quote summary once I've determined which of our companies will be the cheapest for you, what is the best email address for you?

Email address

example@example.com

Are you currently insured?

When did your last policy expire?

Date

Who was that with?

When does your current policy expire?

Date

And who are you currently insured with?

How long have you been insured with them?

IF INSURED WITH CURRENT CARRIER LESS THAN 6 MONTHS: How long have you had continuous coverage?

Notes (IF NEEDED)

Now that we are independent, we have a lot of different discounts that each company offers so let me go through those real quick to see which discounts you want.

So, before I get all of the information about your vehicles, I always like to start off with the fun stuff which is to see if we can save you some money by going through the discounts you can take advantage of!

Some of our companies offer a paperless discount if you were to receive all of your bills and policy documents like insurance id cards via email. Would you be interested in receiving that discount?

We have some companies that offer an upfront 10% discount for a telematics program where they monitor your driving for 5 months looking for hard brakes, rapid acceleration and driving between 12AM and 5AM. Then after the program you can get up to a 40% discount based on your driving habits. They don't penalize you for bad driving, it's only used as a discount. Would you be interested in that?

I don't see where we have your homeowners insurance. Do you own your own home?

Do you own your own home?

Homeownership

Who is your home insurance with?

Who is your condo insurance with?

Who is your townhome insurance with?

Who is your mobile home insurance with?

Who is your renters insurance with?

Is your home insured with {andWho} as well?

Is your condo insured with {andWho} as well?

Is your town home insured with {andWho} as well?

Is your mobile home insured with {andWho} as well?

Is your renters insured with {andWho} as well?

Ok, after I'm done getting the information I need on your auto insurance, I'll get some information about your home so you can get that discount too because that's actually the largest discount you can get.

OBJECTION:

I'm just getting a quote on my auto today.

We will actually take a look at it both ways for you. A lot of times people end up paying more if they have their insurance with two different places and also you could be left with some exposures so that way you can look at your options and choose at the end of this conversation what is best. Sound good?

Ok, after I'm done getting the information I need on your auto insurance, I'll get some information about your condo so you can get that discount too because that's actually the largest discount you can get.

OBJECTION:

I'm just getting a quote on my auto today.

We will actually take a look at it both ways for you. A lot of times people end up paying more if they have their insurance with two different places and also you could be left with some exposures so that way you can look at your options and choose at the end of this conversation what is best. Sound good?

Ok, after I'm done getting the information I need on your auto insurance, I'll get some information about your townhome so you can get that discount too because that's actually the largest discount you can get.

OBJECTION:

I'm just getting a quote on my auto today.

We will actually take a look at it both ways for you. A lot of times people end up paying more if they have their insurance with two different places and also you could be left with some exposures so that way you can look at your options and choose at the end of this conversation what is best. Sound good?

Ok, after I'm done getting the information I need on your auto insurance, I'll get some information about your mobile home.

OBJECTION:

I'm just getting a quote on my auto today.

We will actually take a look at it both ways for you. A lot of times people end up paying more if they have their insurance with two different places and also you could be left with some exposures so that way you can look at your options and choose at the end of this conversation what is best. Sound good?

Ok, after I'm done getting the information I need on your auto insurance, I'll get some information about your renters so you can get that discount too because that's actually one of the largest discounts you can get.

OBJECTION:

I'm just getting a quote on my auto today.

We will actually take a look at it both ways for you. A lot of times people end up paying more if they have their insurance with two different places and also you could be left with some exposures so that way you can look at your options and choose at the end of this conversation what is best. Sound good?

Did they agree to let you quote their Home?

Did they agree to let you quote their Condo?

Did they agree to let you quote their Townhome?

Did they agree to let you quote their Mobile home?

Did they agree to let you quote their Renters?

Would you want to save money by having your monthly premiums automatically deducted from your checking or savings account? That can save up to $60 a year just from that with some of our carriers.

Some of our carriers give a 10% discount if the total premiums are paid in full. Depending on what the total premium comes back at, is paying the total premium in full an option you would like to save even more money?

Are you a member of any Federal Credit Unions?

What credit union are you a member of?

Paperless

Telematics

Home-Car2

EFT

PayInFull2

FedCU

Ok, so to recap, you are interested in the {Telematics2}, {Paperless2}, {payinfull2}, {homecar2}, {eft2}, {fedcu} {fedcu4} {fedcu2} {fedcu3}

As far as coverages, I’ll quote this identical to what you currently have and then once we determine which company is the lowest cost, we will review your coverages at that time to see if you want to make any changes.

At {agencyName}, we have a couple of different options for car insurance. The first one is like most policies out there where if you have an accident, your rates go up. We also offer one where they wouldn’t. Which one do you think you would prefer?

Accident Forgiveness

So we also offer policies like everyone else where if you get a minor violation like a speeding ticket, your rates will go up but we also offer policies that if you get a minor violation it won't go up. Which of those do you prefer?

Minor Violation Forgiveness

Next, we’ll go through your coverage.

The first coverage on your policy is what we call liability. Liability pays if you hurt somebody else in an accident, and is what I consider the most important coverage you have on your policy. With liability, you’re actually able to pick how much protection you have.

What limits do you have now? Typically it will say Bodily Injury liability and then two numbers like 50/100 which stands for $50,000 per person up to $100,000 per accident for bodily injury.

You may also see something that says Property Damage and that may just have one number like 50 which stands for $50,000.

Do you remember why you would have chosen those amounts?

Not Sure, Agent Picked Them "No" OR "I don't know" Always Had Same Limits Since I Was __ Years Old Determined Limits Needed through a Needs Assessment With Attorney, CPA or Insurance Agent Wanted Higher Limits So Just Increased Them Other

We hear that a lot. That’s exactly why I ask and why I like to go through the quote like this. It just helps to make sure you are properly protected. So, with liability, a general rule is that you always want to have at least as much coverage as what your total assets are worth. A lot of clients don’t realize that if they caused an accident where the charges went over the amount you are covered for, you would actually be sent a bill for the rest. Does that make sense?

Oh wow! Most people aren't that diligent about protecting their assets. You're obviously a very financially responsible person. Well, if you don't mind, let's take 1 minute just to make sure your limits are still adequate. Does that sound good to you?

Oh ok. Well that's very smart of you because a lot of people just drive around with the bare minimum. So, with liability, a general rule is that you always want to have at least as much coverage as what your total assets are worth. A lot of clients don’t realize that if they caused an accident where the charges went over the amount you are covered for, you would actually be sent a bill for the rest. Does that make sense?

Oh ok. So, with liability, a general rule is that you always want to have at least as much coverage as what your total assets are worth. A lot of clients don’t realize that if they caused an accident where the charges went over the amount you are covered for, you would actually be sent a bill for the rest. Does that make sense?

They Gave

We Helped

Great. So, what do you think a ballpark figure for what your total assets are worth would be?

DO YOU NEED TO HELP THEM FIGURE OUT THEIR TOTAL ASSETS?

No problem, we can figure this out together. How much is your home worth?

How much are your cars worth?

How much are your retirement or investment accounts worth?

How much money do you have total in the bank?

How much is all of your personal property like jewelry, furniture etc in your house worth?

Total Assets We Help

Liability Limits They Tell Total Assets

Liability Limits We Help With Total Assets

Okay, so you are estimating your total assets to be around ${theyGave} which means that we should have liability limits of at least {theytell} to properly protect yourself in case a bad accident were to occur, does that sound reasonable?

Okay, so you are estimating your total assets to be around {weHelped} which means that we should have liability limits of at least {wehelp} to properly protect yourself in case a bad accident were to occur, does that sound reasonable?

The next coverage is called Medical Expense and it pays for all reasonable and necessary expenses for medical, hospital and emergency medical services as well as funeral expenses as a result of an accident for you or anyone else in your vehicle. Most of our carriers offer limits ranging from $500 to $25,000. This coverage is completely optional but if you don't have any health insurance I would absolutely add this to the policy. Do you know what limit you want?

Just to let you know, the insurance companies pull what is called an "insurance score" which does show as a soft hit on your credit. It does not affect your credit but it will show that the insurance company pulled your credit. Also, we do not get to see your credit, but your insurance score is a rating factor with just about every insurance company out there now so this isn't anything new, but I just wanted you to know why I would need your date of birth and social security number now that we are at the point where I need driver information.

How many drivers in the household are there?

Driver 1

First Name

Last Name

Relationship

Gender

Marital Status

Date of Birth *

current date1

Date

age driver 1

Social Security Number

Age First Licensed

Drivers License Number

Driver's License State

What is their highest level of education completed?

What is their occupation AND City of Employer?

Are you a full time student with a 3.0 GPA or higher or just recently graduated with a 3.0 GPA or higher?

Driver 2

First Name

Last Name

Relationship

Gender

Marital Status

Date of Birth

Date

current date2

Date

age driver 2

Social Security Number

Age First Licensed

Drivers License Number

Driver's License State

What is their highest level of education completed?

What is their occupation AND City of Employer?

Are you a full time student with a 3.0 GPA or higher or just recently graduated with a 3.0 GPA or higher?

Some carriers give a discount for monitoring your teenager's driving with a GPS device. Would you be interested in that discount?

IF THEY ARE A STUDENT: Are they over 100 miles away with a vehicle or over 100 miles away without a vehicle? If they are over 100 miles away with a vehicle, you will get a garaging address later.

Are they requesting that this person be excluded as a driver?

No Yes

Why should this person be excluded as a driver?

Unlicensed Suspended License Listed As Driver On Another Policy Other

Explain "Other" reason for excluding this driver.

Driver 3

First Name

Last Name

Relationship

Gender

Marital Status

Date of Birth

Date

current date3

Date

age driver3

Social Security Number

Age First Licensed

Drivers License Number

Driver's License State

What is their highest level of education completed?

What is their occupation AND City of Employer?

Are you a full time student with a 3.0 GPA or higher or just recently graduated with a 3.0 GPA or higher?

Some carriers give a discount for monitoring your teenager's driving with a GPS device. Would you be interested in that discount?

IF THEY ARE A STUDENT: Are they over 100 miles away with a vehicle or over 100 miles away without a vehicle? If they are over 100 miles away with a vehicle, you will get a garaging address later.

Are they requesting that this person be excluded as a driver?

No Yes

Why should this person be excluded as a driver?

Unlicensed Suspended License Listed As Driver On Another Policy Other

Explain "Other" reason for excluding this driver.

Driver 4

First Name

Last Name

Relationship

Gender

Martial Status

Date of Birth

Date

current date4

Date

age driver 4

Social Security Number

Age First Licensed

Drivers License Number

Driver's License State

What is their highest level of education completed?

What is their occupation AND City of Employer?

Are you a full time student with a 3.0 GPA or higher or just recently graduated with a 3.0 GPA or higher?

Some carriers give a discount for monitoring your teenager's driving with a GPS device. Would you be interested in that discount?

IF THEY ARE A STUDENT: Are they over 100 miles away with a vehicle or over 100 miles away without a vehicle? If they are over 100 miles away with a vehicle, you will get a garaging address later.

Are they requesting that this person be excluded as a driver?

No Yes

Why should this person be excluded as a driver?

Unlicensed Suspended License Listed As Driver On Another Policy Other

Explain "Other" reason for excluding this driver.

Driver 5

First Name

Last Name

Relationship

Gender

Martial Status

Date of Birth

Date

current date5

Date

age driver 5

Social Security Number

Age First Licensed

Drivers License Number

Driver's License State

What is their highest level of education completed?

What is their occupation AND City of Employer?

Are you a full time student with a 3.0 GPA or higher or just recently graduated with a 3.0 GPA or higher?

Some carriers give a discount for monitoring your teenager's driving with a GPS device. Would you be interested in that discount?

IF THEY ARE A STUDENT: Are they over 100 miles away with a vehicle or over 100 miles away without a vehicle? If they are over 100 miles away with a vehicle, you will get a garaging address later.

Are they requesting that this person be excluded as a driver?

No Yes

Why should this person be excluded as a driver?

Unlicensed Suspended License Listed As Driver On Another Policy Other

Explain "Other" reason for excluding this driver.

Driver 6

First Name

Last Name

Relationship

Gender

Martial Status

Date of Birth

Date

current date6

Date

age driver6

Social Security Number

Age First Licensed

Drivers License Number

Driver's License State

What is their highest level of education completed?

What is their occupation AND City of Employer?

Are you a full time student with a 3.0 GPA or higher or just recently graduated with a 3.0 GPA or higher?

Some carriers give a discount for monitoring your teenager's driving with a GPS device. Would you be interested in that discount?

IF THEY ARE A STUDENT: Are they over 100 miles away with a vehicle or over 100 miles away without a vehicle? If they are over 100 miles away with a vehicle, you will get a garaging address later.

Are they requesting that this person be excluded as a driver?

No Yes

Why should this person be excluded as a driver?

Unlicensed Suspended License Listed As Driver On Another Policy Other

Explain "Other" reason for excluding this driver.

Has anyone's license been suspended or revoked in the last 5 years?

Whose license was suspended or revoked and why?

Does anyone require an SR-22 or FR-44?

Who requires the SR-22 or FR-44 and why? Do you know how much longer they require it?

Does anyone have any minor violations like speeding tickets or accidents in the past 3 years?

What minor violations or accidents are there and approximate dates of these incidents?

Does anyone have any major violations in the past 5 years like reckless driving or a DUI?

Who has a major violation, what was it and approximate date?

Has anyone taken a defensive driver course or any other type of driver education course in the past 3 years?

Who took a defensive driver course and when?

How many vehicles are in the household?

Vehicle 1

Vehicle ID Number

Year

Make

Model

Does it have Automatic Braking Technology where if someone pulls out in front of you it automatically slows down?

Does it have Blind Spot Warning that was Factory Installed?

Does it have any Anti Theft alarm systems on it?

Are you the original owner of the vehicle or how long have you owned it?

Did you want full coverage of liability only?

Comprehensive Deductible

Collision Deductible

Do you want Rental on this vehicle?

How is the vehicle used? Pleasure, business or to and from work or school?

How many miles one way is it to work?

How many days per week is it driven to and from work?

How many miles one way is it to school?

How many days per week is it driven to and from school?

What type of business is it used for?

What would you say is the total annual mileage driven on this vehicle?

Vehicle 2

Vehicle ID Number

Year

Make

Model

Does it have Automatic Braking Technology where if someone pulls out in front of you it automatically slows down?

Does it have Blind Spot Warning that was Factory Installed?

Does it have any Anti Theft alarm systems on it?

Are you the original owner of the vehicle or how long have you owned it?

Did you want full coverage of liability only?

Comprehensive Deductible

Collision Deductible

Do you want Rental on this vehicle?

How is the vehicle used? Pleasure, business or to and from work or school?

How many miles one way is it to work?

How many days per week is it driven to and from work?

How many miles one way is it to school?

How many days per week is it driven to and from school?

What type of business is it used for?

What would you say is the total annual mileage driven on this vehicle?

Vehicle 3

Vehicle ID Number

Year

Make

Model

Does it have Automatic Braking Technology where if someone pulls out in front of you it automatically slows down?

Does it have Blind Spot Warning that was Factory Installed?

Does it have any Anti Theft alarm systems on it?

Are you the original owner of the vehicle or how long have you owned it?

Did you want full coverage of liability only?

Comprehensive Deductible

Collision Deductible

Do you want Rental on this vehicle?

How is the vehicle used? Pleasure, business or to and from work or school?

How many miles one way is it to work?

How many days per week is it driven to and from work?

How many miles one way is it to school?

How many days per week is it driven to and from school?

What type of business is it used for?

What would you say is the total annual mileage driven on this vehicle?

Vehicle 4

Vehicle ID Number

Year

Make

Model

Does it have Automatic Braking Technology where if someone pulls out in front of you it automatically slows down?

Does it have Blind Spot Warning that was Factory Installed?

Does it have any Anti Theft alarm systems on it?

Are you the original owner of the vehicle or how long have you owned it?

Did you want full coverage of liability only?

Comprehensive Deductible

Collision Deductible

Do you want Rental on this vehicle?

How is the vehicle used? Pleasure, business or to and from work or school?

How many miles one way is it to work?

How many days per week is it driven to and from work?

How many miles one way is it to school?

How many days per week is it driven to and from school?

What type of business is it used for?

What would you say is the total annual mileage driven on this vehicle?

Vehicle 5

Vehicle ID Number

Year

Make

Model

Does it have Automatic Braking Technology where if someone pulls out in front of you it automatically slows down?

Does it have Blind Spot Warning that was Factory Installed?

Does it have any Anti Theft alarm systems on it?

Are you the original owner of the vehicle or how long have you owned it?

Did you want full coverage of liability only?

Comprehensive Deductible

Collision Deductible

Do you want Rental on this vehicle?

How is the vehicle used? Pleasure, business or to and from work or school?

How many miles one way is it to work?

How many days per week is it driven to and from work?

How many miles one way is it to school?

How many days per week is it driven to and from school?

What type of business is it used for?

What would you say is the total annual mileage driven on this vehicle?

Vehicle 6

Vehicle ID Number

Year

Make

Model

Does it have Automatic Braking Technology where if someone pulls out in front of you it automatically slows down?

Does it have Blind Spot Warning that was Factory Installed?

Does it have any Anti Theft alarm systems on it?

Are you the original owner of the vehicle or how long have you owned it?

Did you want full coverage of liability only?

Comprehensive Deductible

Collision Deductible

Do you want Rental on this vehicle?

How is the vehicle used? Pleasure, business or to and from work or school?

How many miles one way is it to work?

How many days per week is it driven to and from work?

How many miles one way is it to school?

How many days per week is it driven to and from school?

What type of business is it used for?

What would you say is the total annual mileage driven on this vehicle?

Do you want Roadside assistance in case a vehicle breaks down and you have to get it towed?

Notes about Roadside (IF NEEDED)

Are any of the vehicles used for Business, Uber or Lyft or delivery?

Notes about Business, Uber or Lyft or delivery (Who drives what vehicle and how do they use it?

Have any of the vehicles been customized in any way like wheelchair lifts, expensive stereo equipment, rims or graphics?

Notes about customization i.e. what vehicle, $ amount, description of customization etc.

Who Drives what vehicle primarily?

TYPE THE DRIVER'S NAME BELOW THE VEHICLE THEY DRIVE PRIMARILY

{year} {make} {model}

{year240} {make241} {model242}

{year263} {make264} {model265}

{year285} {make286} {model287}

{year328} {make329} {model330}

{year349} {make350} {model351}

Notes about who drives what (IF NEEDED)

Is there a lien on any vehicle or are any of the vehicles leased?

{year} {make} {model}

{year240} {make241} {model242}

{year263} {make264} {model265}

{year285} {make286} {model287}

{year328} {make329} {model330}

{year349} {make350} {model351}

vehicles over 100 miles away

Are any of the vehicles garaged at a different address than where you live? {vehiclesOver}

{year} {make} {model}

{year240} {make241} {model242}

{year263} {make264} {model265}

{year285} {make286} {model287}

{year328} {make329} {model330}

{year349} {make350} {model351}

Does anyone have a company car that they take home with them?

DESCRIBE WHO HAS A COMPANY CAR THAT THEY TAKE HOME WITH THEM

Does anyone frequently use anyone else's vehicle that isn't listed on the policy such as a friend's vehicle, a roommate or a relative's vehicle?

DESCRIBE WHO MIGHT ELSE USE THE VEHICLE FREQUENTLY AS THEY MAY NEED TO BE ADDED AS A DRIVER. YOU MAY WANT TO GET THEIR NAME, DATE OF BIRTH AND LICENSE NUMBER AND A GOOD DESCRIPTION OF HOW FREQUENTLY, WHICH VEHICLE AND WHY THE VEHICLE IS USED.

Ok, that takes care of the auto. Now I just need to get some information on the homeowners.

Ok, that takes care of the auto. Now I just need to get some information on the condo.

Ok, that takes care of the auto. Now I just need to get some information on the townhome.

Ok, that takes care of the auto. Now I just need to get some information on the mobile home.

Ok, that takes care of the auto. Now I just need to get some information on the renters.