MM Insurance - Personal Lines Onboarding Info

MM Insurance - Personal Lines Onboarding Info

Home And Auto Proposal

Please complete the fields below to the best of your knowledge. If you do not know the information please leave the field blank.
Reply Email
example@example.com
Policy Type
Monday.com Title
Customer First Name
Customer Last Name
Customer Full Name
Customer Birthdate

MonthDayYear
Customer Email
example@example.com
Customer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are You Married (If you need auto coverage, we will need your and your spouses drivers license numbers, so please have those handy).
Spouse's First Name
Spouse's Last Name
Spouse's Full Name
Spouse's Date of Birth

MonthDayYear
Date
Desired Effective Date You Would Like Coverage To Start

MonthDayYear
Date
Do you have a dog(s)
Please describe the breed(s). (Certain breeds are a problem for insurance companies. Be sure to disclose yours). P.S - What's your dog's name :)
Did you have any claim(s) in the past 5 years?
Please describe the claim(s).
Are You Seeking a Homeowners Policy or Renter's Policy
Is This A New Property Purchase?
What Is Your Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Insurance Carrier (If none, type "NA" or "New Property Purchase")
Property Address

Street Address

Street Address Line 2

CityState

Zip Code
What Is Your Desired Deductible
Select Any Protective Device You Have In The Home

Other
Is There A Mortgage On The Property
What Is The Name & Contact Information Of The Lender
Year Built Of Your Home
Year Property Was Purchased
Approximate Finished Square Footage Above Ground (Not Including Basement)
What Is The Age Of The Roof. (Roofs Over 20 Years Old May Present Underwriting Challenges, Please Make Sure Roof Age Is Accurate).
Does the home have a wood burning stove or fireplace?
Please describe the stove. (Ex: pellet stove, wood burning fireplace etc.)
Foundation Type
Are You Concerned About Water Backing Up Into The Basement
What Limit Of Insurance Would You Like To Have In The Event Of Water Backup In The Basement
Is Any Part Of The Basement Finished?
Approximate Square Footage Of Finished Area In Basement
Does the basement have a sump pump?
Does The Property Have A Garage?
Are There Any Other Structures On The Property?
Please Describe The Other Structures
What Type(s) Of Siding Does The Home Have?

Other
What Type(s) of Siding does the Home Have?
Ex: Brick, Vinyl, Wood, Stucco, Other Types
Do you have the ability to Upload / Take a photo of your home right now to verify the materials of roof and siding construction?* (Note: If your home is over $500,000 we will need photos of all four sides of your home).
Please Upload The Photo(s)

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Does The Property Have A Pool?
Does the pool have a fence with a locked gate and/or automatic safety cover?
Does the pool have a locked gate?
Has There Been Any Plumbing Updates Done To The Property (Remodeling)?
Please Describe The Update And What Year The Update Occurred?
Has There Been Any Electrical Updates Done To The Property (Remodeling)?
Please Describe The Update And What Year The Update Occurred?
Has There Been Any HVAC Updates Done To The Property (Have You Replaced An Air Conditioner Or Furnace)?
Please Describe The Update And What Year The Update Occurred?
Have You Replaced The Roof On Your Home Since It Was Built?
Please Describe The Update And What Year The Update Occurred?
Has There Been Any Other Updates Done To The Property?
Please Describe The Update And What Year The Update Occurred?
Do You Have Other Owned Rental Properties Or Vacation Homes?
Do You Desire Personal Auto Coverage?
What Is Your Driver's License Number
Drivers License State (Abbreviation - ie WI or IL)
Are There Other Household Driver's Besides Yourself (ie - Child Or Other Relative Regularly Driving Your Vehicle)?
Please provide DL for you and your spouse as well as the DL Number and **DATE OF BIRTH** for any other additional listed drivers in the home.
Ex: John Smith, 3-21-85, J540-887755, WI
Do you have anyone living in your home (household member) age 15 or older that does not have a driver's license yet?
Do You Desire Rental Reimbursement Coverage? (In The Event Of A Claim, Insurance May Pay For Car Rental Expenses).
Do You Desire Roadside Assistance Coverage?
What Is Your Desired Deductible
How Many Vehicles Need Coverage?
Vehicle 1 Year
Vehicle 1 Make & Model
Would You Like To Take A Picture Of The VIN # Or Enter It Manually For Vehicle 1?
Upload An Image Of The VIN # For Vehicle 1

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Vehicle 1 VIN #
Vehicle 2 Year
Vehicle 2 Make & Model
Would You Like To Take A Picture Of The VIN # Or Enter It Manually For Vehicle 2?
Upload An Image Of The VIN # For Vehicle 2

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Vehicle 2 VIN #
Vehicle 3 Year
Vehicle 3 Make & Model
Would You Like To Take A Picture Of The VIN # Or Enter It Manually For Vehicle 3?
Upload An Image Of The VIN # For Vehicle 3

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Vehicle 3 VIN #
Vehicle 4 Year
Vehicle 4 Make & Model
Would You Like To Take A Picture Of The VIN # Or Enter It Manually For Vehicle 4?
Upload An Image Of The VIN # For Vehicle 4

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Vehicle 4 VIN #
Do you have any non-auto vehicles that you would like covered (ATV, Motorcycle, Boat, Snowmobile, Motorhome, Golf Cart, Trailer, Moped etc).
Please describe the vehicle(s) and include VIN or Serial # if applicable.
Make, Model, Year
Do you have any Jewelry, Fine Art, or Other Collectibles you would like covered? In order to be insured for 'losing' a piece of jewelry, it does have to be listed/scheduled. (It's always good to track down your appraisals - we may need current appraisal.)
Please describe the item(s) and estimated values.
Ex: Womens Engagement Ring White Gold 2 1.6Kt 2.2 carat princess cut diamond color v Clarity xiii Value: $22,000
Do You Desire An Umbrella Liability Policy
What Is Your Desired Amount Of Excess Liability?
Is there anything else you are concerned about insuring that was not mentioned in the questions above?
If you wish to include any images of your ID cards, Dec Pages, or Policy Pages, Jewelry Appraisals please upload them here. (If you have more than 4 vehicles, this is where you can add images of their corresponding VIN #s).

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Are You A Current MM Customer
How did you hear about MM?
How Did You Hear About MM
Where Online Did You Find Us?
Who Referred You? We'd Love To Send Them A Gift!
Customer / Prospect
Are you in a rush? Would you like to move to the front of the line to get your proposal back?

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