Point of Sale (P-Lines)

Complete this point of sale when you've bound a policy. This will add an entry to the sales board and also help with tracking compensation.

NOTE: 1-We must never bind a policy without a signed application (not just a proposal), 2-Money to pay for the policy (except Mtg Impounds)

Sales Count*

The reason for the policy

Binding Date

Completed By*

Assigned BOB*

Policy Lines*

Is this a transfer within the Agency?*

a transfer is a Rewrite from one carrier to another within the last 3 years

Reason for Policy*

The reason for the rewrite of the policy

Reason for Policy*

The reason for the policy

What is Prior Policy # / Rewrite of

Source of Policy*

New Business Defined: a brand new policy being written for either an existing client or a new client to our agency.

Rewrite Business Defined: a policy requiring a new application and has to be re-written either for underwriting reasons or cancellation due to non-payment.

Renewal Business Defined: a policy that is being renewed with the same carrier. Its understood that some carriers/mga's may require an application to renew the policy but for tracking and accounting purposes, this is not considered a new business or rewrite business within the agency.

How did we obtain this business*

Source of Business

What is the name of the person or business that sent us the referral*

Address of the person or business that sent us the referral (map it)

	Address
Street
City
State
Zip

For mapping (Obtained via)

First Applicant:

First & Last Name (1st App)*

as listed on driver license

Gender (1st App):

Marital Status (1st App):

What is the EZLynx Client ID *

Applicant Home Number (1st App):

Gather if not in client file already

Applicant Mobile Number (1st App):

Gather if not in client file already

Applicant Email Address (1st App):

Gather if not in client file already

Birthdate (1st App)

Date

Employment Status (1st App):

as listed on driver license

Occupation / Job Title (1st App):*

Example: Science or Engineering Degree

Self-Employed (1st App)?*

Nature of work/business (1st App):*

Second Applicant:

First & Last Name (2nd App)*

as listed on driver license

Gender (2nd App):

Marital Status (2nd App):

Applicant Home Number (2nd App):

Gather if not in client file already

Applicant Mobile Number (2nd App):

Gather if not in client file already

Applicant Email Address (2nd App):

Gather if not in client file already

Birthdate (2nd App)

Date

Employment Status (2nd App):

as listed on driver license

Occupation / Job Title (2nd App):*

Example: Science or Engineering Degree

Self-Employed (2nd App)?*

Nature of work/business (2nd App):*

Applicant Address:

Physical Location of Home (map it) *

	Address
Street
City
State
Zip

Address Type*

Address (map it) *

	Address
Street
City
State
Zip

Placement of Coverage:

What is the policy number or quote number (Do not just enter TBD)*

Enter the policy or quote #

Who did you bind this with*

Term of Policy*

# of days (do not delete for calculation)

PL Carrier (Master Company)*

Master Company in Ezlynx

PL Carrier (Writing Company)*

Writing Company in Ezlynx

Choose the MGA*

Master Company in Ezlynx

MGA Writing Company*

Writing Company in Ezlynx

For mapping (Carrier/MGA)

What does this policy cover*

Line of Business in Ezlynx*

This is the LOB Ezlynx will shows

Master Policy (for conditioning)

do not delete

Property Products (for conditioning)

do not delete

Policy Billing: Type of billing in the industry

-

Direct Bill Policies: When insurance carriers offer a payment plan. Usually clients will have an option to pay a downpayment and then pay the remainder on installment plan.

-

Agency Billed Policies: When insurance carriers do not offer a payment plan and wants the policy paid in full. However, a 3rd party finance company can be used to provide a client with a pay plan option. This means the 3rd party finance company will pay the policy in full for the customer and the client will pay back the finance company on a pay plan. There are additional cost associated with this option since interest charges are included in the payments.

Note: When a carrier provides a quote then it will show if there is a pay plan option, if not offered then we utilize a 3rd party finance company called IPFS to give a client the option for a payment plan (downpayment + monthly payments).

We do not use any other finance company, many of the MGA's will give a 3rd party finance company that they work with. But we are signed up directly with IPFS and therefore can do the quote/setup very quickly ourselves.

For complete instructions, check with Mo and go to this IPFS page.

What is the billing type*

Get help if needed, do not guess

Will this be Financed thru IPFS *

Did you finalize and submit the finance agreement thru IPFS website *

Note: Do not complete this point of sale until you have submitted and finalized the finance agreement thru IPFS website. You must always complete the finance agreement transmission first.

How is this policy being paid*

Who is this payable to?*

How is this policy being paid

Premium Breakdown (Direct Billed Policies):

Total Policy Premium (Pure)*

Without any fees

Amount paid to start the policy*

Amount Including Broker Fee (if any)

Amount of Policy Fee (if Any)*

Amount of LSI Broker Fee (DB)*

What did we charged for LSI fee

Broker Fee to Acc. Manager (DB)*

What did we charged for LSI fee

Amount to Carrier/Wholesaler*

Have you paid the carrier yet*

Note: Mo will pay the carrier after you submit the point of sale.

Direct-New Bus. Prem (for mapping)

Direct-Rewrite Prem (for mapping)

Premium Breakdown (Agency Billed Policies):

Total Policy Premium (Pure)*

Without any fees

Amount paid to start the policy*

Total amount including broker fee

Commission % from MGA*

Comm from MGA or Wholesaler

Commissions Amount to LSI*

Commission in Dollars to LSI

Policy Fee*

Surplus Line Tax*

Stamping Fee*

Inspection Fee*

Wholesaler Broker Fee*

Amount of LSI Broker Fee (AB)*

What did we charged for LSI fee

Broker Fee to Acc. Manager (AB)*

What did we charged for LSI fee

Payment amount to send Carrier/MGA*

Amount Paid - LSI Comm & Bk Fee

Agency-New Bus. Prem (for mapping)

Agency-Rewrite Prem (for mapping)

New Bus. Prem

For mapping (do not delete)

Rewrite Prem

For mapping (do not delete)

Bill Type

For mapping (do not delete)

Acc. Man Brk Fee

For mapping (do not delete)

Aegis - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

American Modern- Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

ASI - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Assurant Flood - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Bamboo - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Bristol West - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

CA Fair Plan - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

California Auto Ins. - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

CSE - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Foremost Specialty - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Geovera - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Hagerty - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Hartford - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Hippo - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

ICAT - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Infinity - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Insurance Helper.com - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Kemper Specialty - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Kemper Preferred - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

McGraw - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Mercury (MIC) - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Nationwide - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Palomar Specialty - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Progressive - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Safeco - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Sagesure.com - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Stillwater - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Swyfft - Application and Document Retention Policy:

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Travelers - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Urban Advantage - Application and Document Retention Policy:

Auto Policy Binding:

Did we exclude any drivers*

Does this policy have any Excluded Drivers.

Do we have a signed exclusion*

Did the client Reduce UM Coverage*

Was this policy transmitted with UM limits lower than the liability limits (Reduction of Uninsured Motorist).

Do we have a signed UM Reduction form*

Did the client Reject UM Coverage*

Was the policy transmitted with UM coverage rejected completely.

Do we have a signed UM Rejection form*

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did we give the GS Discount*

Was a Good Student discount given?

Did you get proof for GS Discount*

Did you give Group/Occupation Discount*

Was group/occupation discount given?

Did you get proof for Group/Occupation*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Property/All Other Policy Binding:

Does the client have an Active Umbrella Policy with our agency*

Does this client have an active umbrella policy thru our agency.

Did you add this Risk to the Umbrella Policy*

Did you give a Discount for Alarm System*

Did you get the Alarm Certificate as proof of Discount *

Did you give any other Discount that requires proof*

Did you get the proof for this Discount*

Describe the Discount given*

Did you give MPD on this Policy*

Did you apply the Multi Policy Discount

Did you remember to endorse the Home Policy and give MPD*

Important: You must include/upload the following items before you hit submit.

1 - LSI Agency Proposal given to client.

2 - Actual quote/proposal given to us by the carrier or mga.

3 - Payment information.

A. If payment was collected via paypal, then nothing needs to be attached since I already have a record of it.

B. Bank Account info - If it was a text or email, then just print and attached it so we can pull the money from their account.

Note: You do not need to wait and upload the invoice or binder from the carrier/mga. We do not need this to do the accounting as long as we have the attached the items above.

Upload Signed BOR Form*

Drag n Drop or Browse

Upload Files (Must attached proof of binding / Invoice)*

Browse Files

Notes / Comments

PRC Code (Jasmine only)

Accounting (Handled by Mo)

Direct Bill Accounting

	Breakdown
Amount Paid
LSI BK Fee
Amount to Carrier/MGA

Agency Bill Accounting

	Breakdown
Pure Premium
Amount Paid
Comm %
Comm In Dollars
LSI BK Fee
Amount to Carrier/MGA

Ezlynx Data Entry:

Line of Business

Written Premium

Pure Premium without any fees

Full Term Premium

Total Policy Cost (without our Bk Fee)

Transaction type

Estimated Fees

All Fees except our Broker Fee

Annual Premium

Total Cost Including BK Fee (if any)

for spacing

Estimated Taxes

Tax on Policy (non-admitted Only)

Policy #

Note: You must enter this as another policy in EZLynx since it was indicated as a trasnfer within the agency. Do not simply renew the existing/prior policy number.

Effective Date

Date

Expiration Date

Date

Calculation (do not delete)

Description

Master Company

Policy Download: This carrier will download an electronic copy of a policy, therefore you do not need to manually create the policy. You must wait for the download to arrived in ezlynx that will automatically create the policy however you can also check the ezlynx download inbox for any unmatched download.

Policy Entry: This carrier does not offer IVANS download, therefore you need to manually create the policy in ezlynx.

Writing Company

Rating State

LOB Orig Date

Producer Code Override

Craig

Producer Code Override

Allan

Producer Code Override

Jack

Producer Code Override

Omar

Producer Code Override

Felix

Producer Code Override

Pattie

Producer Code Override

Penny

Policy Source Verification: We must verify the source of the policy in accordance with our agency definitions for new business/rewrite/renewal

Was this a transfer within the Agency*

a transfer is a Rewrite from one carrier to another within the last 3 years

Reason for Policy Verified as New Bus*

The reason for the rewrite of the policy

Reason for Policy Verified as Rewrite*

The reason for the policy

Source of Policy updated in ezlynx*

New Business Defined: a brand new policy being written for either an existing client or a new client to our agency.

Rewrite Business Defined: a policy requiring a new application and has to be re-written either for underwriting reasons or cancellation due to non-payment.

Renewal Business Defined: a policy that is being renewed with the same carrier. Its understood that some carriers/mga's may require an application to renew the policy but for tracking and accounting purposes, this is not considered a new business or rewrite business within the agency.

Transfer Info to: