Create IT Ticket
Date
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/
Month
/
Day
Year
Date
Agency Name
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Please Select
LSI
enter agency prefix
Assign to
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Please Select
Rein
Rikki
Ed
If Unknown Pick Rein
Requested By
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Please Select
Mo
Omar
Leo
Other
Other: Requested by:
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IT Request Type:
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Create a New Item
Update an Existing Item
Create a New Item
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Create a New BNA
Create a New Jotform
Create a New Sheet
Create a New Zap
Create a New DB Page
Create a New RT Page
Create a New Maple
Create New Text Template
Create New Email Template
Other
Scroll Text on DB
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Yes
No
Scroll Update
Update an Existing Item
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Update an Existing Jotform,
Update an Existing Sheet,
Update an Existing Zap,
Update an Existing DB Page,
Update an Existing RT Page,
Update Last Pass an/or LP Master List
Update Text Template
Update Email Template
Other
Update an Existing Jotform
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Update a Purl Jotform,
Update a P-Card Jotform,
Update a PST Jotform,
Update a PST Card Jotform,
Update a CPA Jotform,
Update a EOI Jotform,
Update a SL2 Jotform,
Update a Fair Plan Indication Jotform,
Update a BOR Jotform,
Update a Referral Jotform,
Update the DOP Jotform,
Update the DTP Jotform,
Update the Record of Claim Jotform,
Update the Trust Payment Jotform,
Update the Collect Payment via Paypal Jotform,
Update the Employee Onboarding / Removal Jotform,
Update the New Employee Application Jotform,
Update the Certificate of Employment Jotform,
Update the Equipment Replacement Jotform,
Update the Password Update Request Jotform,
Update the New Market Onboarding Jotform,
Update the Find a Market Jotform,
Update the Point of Sale Jotform,
Update the Guideline Update Jotform,
Update the Create an Invoice Jotform,
Update the IT Task Request Jotform,
Update the State of No Loss Jotform,
Update the Referral to Allied Brokers Jotform,
Update the MER Jotform,
Update or Submit E&O Information to Carrier,
Update New Referral Source Jotform,
Update within CPA
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Carrier Section for Validation
Carrier Announcement
Simplified Guidelines
Maple
Guideline Item
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New Bus Suspension
Age / Type of Electrical System
Age / Type of Plumbing
Age / Type of Primary Heating:
Age / Type of Secondary Heating:
Age of Building:
Bars on Windows:
Breed / Type of Dog:
Business Exposure:
Capacity / Saturation of Area:
Claim History:
Day Care Business on Premises:
Employment / Occupation:
Exceeds Coverage A Limit or TIV:
Exposure to Wildfire/ Brush for a DIC Policy:
Exposure to Wildfire/ Brush for a Full Policy:
Exposure to Water (Lakes, Rivers, Oceans):
Lack of maintenance or Overall Condition:
Log Home Construction:
No Alarm System (Burglar):
No Alarm System (Fire):
No Automatic Gas Shut Off Valve:
Exceeds number of Units for an HO3:
Occupancy/Usage of Property:
Property for Sale:
Property Management:
Property Titled to a Business:
Property Titled to a Trust:
Property Titled to an LLC:
Requires Packaging (Unable to Package):
Residence Employee:
Size of Lot / Acres:
Slope of Property:
Square Footage o Living Area:
Supporting Business:
Swimming Pool:
Trampoline on Premises:
Type of Farm Animal:
Type of Foundation:
Type of Roof:
Under Construction /Remodel:
Wood Stove / Fireplace Inserts:
All Other:
Update an Existing Sheet
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Update a BOB Sheet,
Update a Non-Pay Sheet,
Update a PST Sheet,
Update a UNT Sheet,
Update a DOP Sheet,
Update a POA Sheet,
Update a Sales Log Sheet,
Update a CPA Sheet,
Update a Purl Sheet,
Update a P-Card Sheet,
Update a BOR Sheet,
Update a Referral Sheet,
Update Sales Board,
Recent Announcement Date
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Month
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Day
Year
Date
Recent Announcement Article Number
Recent Announcement Article Description
Link to Form or Item Number
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Describe / Instructions:
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Attachments: (Optional)
Upload a File
Copy of prior policy or prior declarations, etc
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