Re-quote Information
Client Name
*
First Name
Last Name
I am:
*
Client - Must be NAMED Insured on Policy
ISC Employee working with Client
ISC Agent:
Carrie
Jess
Brenda (send PL Rater Summary to Agent)
Zach (send PL Rater Summary to Agent)
Other
ISC Staff / BRIEF Subject Line Message such as "URGENT" "Due 2/10" "Low Priority"
Keep VERY brief please
ISC STAFF/AGENT: Type Quote Requested
Pre-Quote (run through PL and return it to agent)
Requote (send to agent in client-ready format)
Requote (send directly to client)
Rewrite (handle full rewrite directly with client)
In order to run most types of insurance quotes, reports would be generated, such as driving and credit information. Do you give us permission to run the necessary reports to obtain a quote for you? (If you do not want reports run, please discontinue filling out this form and call our office so we can discuss options.)
*
Yes, you have my permission to run the reports you need.
ISC STAFF/AGENT, please check client screen for permission to requote in upper right section of client screen. If not listed as “Yes” reach out to client to obtain permission (document the conversation in AMS) before starting the quote. Do not change the RQ to Yes unless we have SIGNED ongoing permission to requote.
*
Agent/AM is being proactive in request this requote - Check AMS for permission
Client is requesting requote, I have already confirmed with the client that we have 1 time permission to requote (client screen should NOT be updated but we can proceed)
ISC STAFF/AGENT, please provide special instructions here. Please use the fields below for roof info, household info, etc. Using the fields below allows for automated tasks behind the scenes and future info transfer.
i.e. Example: This client only wants to work with Acuity.
Comments / Additional Information
Client e-mail address:
*
example@example.com
Client's Phone Number
-
Area Code
Phone Number
What policies do you want re-quoted?
*
Auto Insurance
Home or Renter's Insurance
Other
ISC Staff/Agent - check this box if you have reviewed AMS and it appears that we already have the education/driver info. Checking this box will hide those questions and processor will use info form AMS.
Info is already in AMS. Please quote accordingly. Thanks!
List Any DRIVERS of your vehicles: (including permit drivers and drivers outside of your household who operate your vehicle(s) more than 4 times per year)
Rows
Name
Highest Education Level
Employer or School Name
Occupation (Job Title) or Grade Level
Miles to Work/School
Primary Vehicle
Primary Residence
Cover on your policy?
Driver 1
In High School
High School Diploma
In College
Some College
Tech/Vocational School
Bachelor's Degree
Master's Degree
Doctorate
GED
Other
Lives in household year-round
Away at school less than 100 miles away
Away at school over 100 miles away (NO CAR AT SCHOOL)
Away at school over 100 miles away (HAS CAR AT SCHOOL)
Primarily lives out of household
Splits time equally between two households
OTHER
Yes, this person should be covered under my policy.
No, this person has their own vehicle and insurance
Other
Driver 2
In High School
High School Diploma
In College
Some College
Tech/Vocational School
Bachelor's Degree
Master's Degree
Doctorate
GED
Other
Lives in household year-round
Away at school less than 100 miles away
Away at school over 100 miles away (NO CAR AT SCHOOL)
Away at school over 100 miles away (HAS CAR AT SCHOOL)
Primarily lives out of household
Splits time equally between two households
OTHER
Yes, this person should be covered under my policy.
No, this person has their own vehicle and insurance
Other
Driver 3
In High School
High School Diploma
In College
Some College
Tech/Vocational School
Bachelor's Degree
Master's Degree
Doctorate
GED
Other
Lives in household year-round
Away at school less than 100 miles away
Away at school over 100 miles away (NO CAR AT SCHOOL)
Away at school over 100 miles away (HAS CAR AT SCHOOL)
Primarily lives out of household
Splits time equally between two households
OTHER
Yes, this person should be covered under my policy.
No, this person has their own vehicle and insurance
Other
Driver 4
In High School
High School Diploma
In College
Some College
Tech/Vocational School
Bachelor's Degree
Master's Degree
Doctorate
GED
Other
Lives in household year-round
Away at school less than 100 miles away
Away at school over 100 miles away (NO CAR AT SCHOOL)
Away at school over 100 miles away (HAS CAR AT SCHOOL)
Primarily lives out of household
Splits time equally between two households
OTHER
Yes, this person should be covered under my policy.
No, this person has their own vehicle and insurance
Other
Driver 5
In High School
High School Diploma
In College
Some College
Tech/Vocational School
Bachelor's Degree
Master's Degree
Doctorate
GED
Other
Lives in household year-round
Away at school less than 100 miles away
Away at school over 100 miles away (NO CAR AT SCHOOL)
Away at school over 100 miles away (HAS CAR AT SCHOOL)
Primarily lives out of household
Splits time equally between two households
OTHER
Yes, this person should be covered under my policy.
No, this person has their own vehicle and insurance
Other
List Any Other Household members who are NOT listed above (including children and un-related roommates). All household members not listed above need to be listed here:
Rows
Name
Why are they not a driver?
Non-Driver 1
Child (under 15 years old)
Child 15+ with temps only
No license/no temps
License suspensed/revoked
They have their own vehicle and insurance
Other
Non-Driver 2
Child (under 15 years old)
Child 15+ with temps only
No license/no temps
License suspensed/revoked
They have their own vehicle and insurance
Other
Non-Driver 3
Child (under 15 years old)
Child 15+ with temps only
No license/no temps
License suspensed/revoked
They have their own vehicle and insurance
Other
Non-Driver 4
Child (under 15 years old)
Child 15+ with temps only
No license/no temps
License suspensed/revoked
They have their own vehicle and insurance
Other
Non-Driver 5
Child (under 15 years old)
Child 15+ with temps only
No license/no temps
License suspensed/revoked
They have their own vehicle and insurance
Other
Check any that apply:
Drive for hire - Uber, Lyft, postal carrier, Amazon, food deliver, etc.
Rent our your vehicle - i.e. Turo
Company vehicle - if you have a vehicle provided by your employer
NONE of these apply
Are any vehicles titled to someone other than you or your spouse? (i.e. titled/co-titled in your kid's names, significant other's name, a business vehicle, etc)?
Do any of your vehicles have non-factory customization? If so, please describe and provide value?
Are any of your assets (homes, vehicles, etc) titled or deeded in another name? Examples could include LLCs, Trusts, parent's names, children's name, unmarried significant other's name, etc. If yes, please explain:
Home Insurance Re-Quote Info:
Rows
Answer
Homeowners and Renters: Do you have a Woodstove, Wood Burner or Pellet Stove in any building? If yes, describe type and location.
Homeowners and Renters:
Any smokers in the household?
Homeowners and Renters:
How many household members?
Homeowners and Renters: Do you have any roomers/boarders?
Homeowners and Renters: Do you conduct any business from home (daycare, piano lessons, auto repairs, sales, etc.)
Homeowners: What percentage of your basement is finished?
Homeowners: Do you have a Battery Backup on your Sump Pump?
Homeowners: Do you rent out any farmland or hunting land?
Homeowners: How many acres of land do you own?
Please describe any remodeling, additions or other changes that we may not be aware of.
Please check all that apply:
ATV/UTV
Boats/watercraft
Trampoline on property
Business (or hobby for money)
Drone
Electronic Bicycles (E-Bikes)
Farm land/farming exposure
Guns / Firearms
Home insurance claims in the past 5 years
Jewelry schedule (i.e. special coverage wanted on higher valued items)
Pool on property
Rental property owned by you
Store property of others (boats, cars, RVs, etc)
Tractors (including garden tractor)
NONE OF THESE APPLY
Other
Does your pool have a slide?
Yes
No
Does your pool have a diving board?
Yes
No
Is there a fence around the pool or yard?
Yes
No
Is there a safety netting around the trampoline?
Yes
No
Is there a fence around the trampoline or yard?
Yes
No
Do you have any animals? If yes, describe type and how many. (If dogs, list the breed)
*
HOME INSURANCE GENERAL DISCOUNTS: Please check any discounts you might be eligible for:
Paid in full
Mortgage Free
Paperless
Metal Roof
HOME PROTECTION DISCOUNTS: Please check any discounts you might be eligible for:
*
Appliance/Fixture Water Shut Off System
Central Burglar Alarm (Professionally Monitored)
Central Fire Alarm (Professionally Monitored)
Central Home Water Shut Off (Professionally Monitored)
Local Burglar Alarm (NOT professionally monitored)
Local Fire Alarm (NOT professionally monitored)
Sprinkler System
Water Leakage Alarm
Smart Home Protection System
None of these apply
Roof Information
*
Rows
If you rent your home check this box, and skip the roof questions.
Age of Roof
Type of Roof
Does roof have existing damage or show signs of lifting, curling, staining or granular loss?
Location 1
Metal
Shingles, 3-tab (very flat surface, no "layering look"
Shingles, Architectural (has a "layered look")
No, the roof is in great condition with no noticeable damage, lifting, curling, staining, algae, or granular loss.
Yes, there may be some existing damage, or signs of lifting, curling, staining, algae, or granular loss.
For Homes OVER 20 years old:
Rows
Answer
Date of plumbing updates, if applicable
Age and type of furnace (i.e. Gas 2012)
Date of electrical updates, if applicable
Signature (on PC/Laptop use your mouse, on a mobile device, use your finger or stylus)
OFFICE USE: By default this form will go to quotes@iscinsurance.com. If you prefer to ALSO receive a copy, please add your email here. Be sure to pull the request from QUOTE FOLDER if you plan to handle yourself.
example@example.com
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