Intra-Agency Prospect Personal Lines Quote Questionnaire

  • Intra-Agency Personal Lines Quote Questionnaire

    This form is specifically for Williamson Insurance & Investments employees. If you are not an employee, please redirect to https://agentwilliamson.com/quote for a more streamlined experience.
  • Team Member Completing Questionnaire
  • Assign this Lead to (BoB):
  • Format: (000) 000-0000.
  • Time at Address
  • Date of Birth
     / /
  • Residence Occupancy
  • Lines to Quote Now
  • Lines to Possibly Quote Later
  • Carriers to Quote Outside of Rater
  • May team contact for additional info?

  • Auto

    Please note: None of the information on this page is required. However, the more information you provide helps us find the most accurate coverage options and rates for you.
  • Desired Effective Date
     / /
  • Would you like to upload documents? Your current Declarations Pages (Policy Documents) can provide information such as VINs and other information about your current situation.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Would you like to enter lienholder info at this time?
  • Coverage Options
  • Further Information

  • Homeowners (HO3/HO5)

    Please note: None of the information on this page is required. However, the more information you provide helps us find the most accurate coverage options and rates for you.
  • Desired Effective Date
     / /
  • Would you like to upload documents? Your current Declarations Pages (Policy Documents) can provide information such as discount qualifications and other information about your current situation.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Add a Second Named Insured? (Spouse, Co-Owner, etc)
  • Second Named Insured DOB
     / /
  • Would you like to add Mortgagee Info at this time?
  • Would you like to provide detailed information about your home? (Square footage, # of Bathrooms, etc.) Unless this is a new-build, we can likely pull information from reports.
  • Select All Applicable Exposures
  • Coverage Options
  • Additional Coverage Options

  • Renters (HO4)

    Please note: None of the information on this page is required. However, the more information you provide helps us find the most accurate coverage options and rates for you.
  • Desired Effective Date
     / /
  • Would you like to upload documents? Your current Declarations Pages (Policy Documents) can provide information such as discount qualifications and other information about your current situation.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Add a Second Named Insured? (Spouse, Co-Owner, etc)
  • Second Named Insured DOB
     / /
  • Would you like to provide detailed information about your home? (Square footage, # of Bathrooms, etc.) Unless this is a new-build, we can likely pull information from reports.
  • Select All Applicable Exposures
  • Coverage Options
  • Additional Coverage Options

  • Condo Owners (HO6)

    Please note: None of the information on this page is required. However, the more information you provide helps us find the most accurate coverage options and rates for you.
  • Desired Effective Date
     / /
  • Would you like to upload documents? Your current Declarations Pages (Policy Documents) can provide information such as discount qualifications and other information about your current situation.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Add a Second Named Insured? (Spouse, Co-Owner, etc)
  • Second Named Insured DOB
     / /
  • Would you like to provide detailed information about your home? (Square footage, # of Bathrooms, etc.) Unless this is a new-build, we can likely pull information from reports.
  • Coverage Options
  • Additional Coverage Options
  • Select All Applicable Exposures

  • Valuable Items

    Please note: None of the information on this page is required. However, the more information you provide helps us find the most accurate coverage options and rates for you.
  • Desired Effective Date
     / /
  • Would you like to upload documents? Your current Declarations Pages (Policy Documents) can provide information such as discount qualifications and other information about your current situation.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Umbrella

  • Landlord Home

    Please note: None of the information on this page is required. However, the more information you provide helps us find the most accurate coverage options and rates for you.
  • Desired Effective Date
     / /
  • Would you like to upload documents? Your current Declarations Pages (Policy Documents) can provide information such as discount qualifications and other information about your current situation.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Second Named Insured DOB
     / /
  • Rows
  • Would you like to add Mortgagee Info at this time?
  • Would you like to provide detailed information about your home? (Square footage, # of Bathrooms, etc.) Unless this is a new-build, we can likely pull information from reports.
  • Do you use a Third-Party Property Manager?
  • Select All Applicable Exposures
  • Coverage Options
  • Additional Coverage Options

  • Life Insurance

    Life Insurance typically requires an in-depth conversation. If you are not the agent handling the quote/policy, please set an appointment for the desired agent.
  • Expected Rating Class
  • Should be Empty: