Add Car Worksheet
YOU MUST SPEAK WITH NAMED INSURED OR 2ND NAMED INSURED
Who's completing this worksheet?
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kim@theinsurancepad.com
lexi@theinsurancepad.com
Is this a quote only?
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YES - Quote Only
NO - Add Car Now
Client's Name
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HawkSoft Number
*
Cell/Main Phone Number
*
Email
*
Verify address - does it match what we have in HawkSoft?
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YES
NO - Need to update
New Address?
When did they purchase/get the new vehicle?
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-
Month
-
Day
Year
Date
Where did they get it?
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Dealership
Private Owner
Already Owned
Dealership Name?
Dealership/Dealer Phone Number?
Please enter a valid phone number.
Year/Make/Model of New Vehicle?
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VIN # of New Vehicle?
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Does New Vehicle Have Automatic Emergency Braking?
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YES
NO
Does New Vehicle Have Blind Spot Warning?
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YES
NO
Who is vehicle titled to?
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Named Insured
Spouse / 2nd Named Insured
Other driver on policy (be sure is eligible with their company)
Other not listed on policy (be sure is eligible with their company)
Name of listed driver vehicle is titled to:
Name AND address of unlisted person vehicle is titled to:
Did they buy or lease the vehicle?
*
Buy - No Loan
Buy - With a Loan
Lease
Name and Address of Lienholder / Leasing Company
*
Enter N/A if does not apply
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What is your current occupation?
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What is Your Highest Level of Education?
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No High School
High School
Vocational/Trade School
Some College
Associates
Bachelors
Graduate Degree/Masters Degree
PhD
Vehicle Usage
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Pleasure
Commute
Business
Explain Business Use
Miles to work, one way?
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Enter N/A if does not apply
How many days/week to you commute to work?
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Enter N/A if does not apply
How many miles do you drive in a year / Annual mileage for this vehicle?
*
Do we need to add a driver / drivers?
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YES
NO
Name, DOB, DL#, SS# and occupation of any/all additional drivers:
Total # of HH Residents?
*
Do we need to add any excluded drivers?
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YES
NO
Name and DOB of any/all new excluded drivers (will need to send exclusion to sign):
Is anyone driving for Uber or Lyft?
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YES
NO
Which vehicle(s)?
Is anyone doing any food delivery for a restaurant, Door Dash, Grub Hub, InstaCart or any other service like that?
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YES
NO
Which vehicle(s)?
Is any vehicle rented to others for a fee using Turo or any other service like that? THIS USAGE WILL BE UNACCEPTABLE WITH ALL OF OUR COMPANIES - IF ANSWER IS YES, STOP WHAT YOU ARE DOING AND SEE KIM
*
YES
NO
Phone Number
Please enter a valid phone number.
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Next
Limits of Liability / UM/UIM (Be sure to match UM/UIM to liability)
*
Please Select
25/50/25
50/100/50
100/300/100
250/500/250
100 CSL
300 CSL
500 CSL
Other
If "other" limits of liability - indicate here:
Is comprehensive/collision coverage requested?
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YES
NO
Comprehensive Deductible?
Collision Deductible?
Is rental reimbursement requested?
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YES
NO
Rental reimbursement limit?
Is roadside assistance or towing/labor requested?
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YES
NO
Roadside or towing/labor limit?
Gap coverage requested (if company offers)?
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YES
NO
Company does not offer
Deductible Savings Bank / Diminishing Deductible requested (if company offers)?
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YES
NO
Company does not offer
Would they like to add telematics to possibly earn discount in the future (must apply to all drivers)
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YES
NO
Company does not offer
Is there any existing damage on the vehicle
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YES
NO
Describe the damage - Have pictures texted if necessary
Did we actually inspect the vehicle?
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YES
NO / Not required
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Do we need to send proof of insurance/verification?
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YES
NO
Attention:
Fax / email?
Did you actually speak to the insured / 2nd named insured / spouse?
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YES
NO
Additional Notes / Comments:
Submit
Should be Empty: