Auto Insurance Quote Form

Page Insurance, Ltd

102 Boston Street

Guilford, CT 06437

(203) 453-5258

info@pageins.com
Effective Date

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Today's Date

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Is this for Commercial or Personal Auto Insurance?

CommericalPersonal Auto
Contact Information
Name

First Name Last Name
DOB

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Occupation
Name

First Name Last Name
DOB

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Occupation
Mailing Address

Street Address

Street Address Line 2

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Phone Number

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Best Time/Date to Contact

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Driver Information
Vehicle Information *Usage = Pleasure (P) Commute (C)
Coverage
Notes
Insured Name

First Name Last Name
Policy Effective Date

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Submitted by*

Agency StaffInsured
Agency Staff
CLIENT INFORMATION Entered in IntellectQUOTE Task Created in IntellectCreate Folder in Scanned docs
Once policy has been sold obtain following Documentation:

Signed Application, quote, payment etc.Signed Cancellation if applicableSigned Flood Selection / Rejection letter or Quote requestSigned Personal Umbrella Quote Selection / Rejection Form
Amend task to Priority "Inbox" assign to ASTRID
Set up policy in Prime
Create contact in PrimeCreate policy (including the A-Trans)Attach the following document in order: (Most documents can be found in insured folder Scanned docs)--- Information sheet--- property card--- replacement cost calculation--- application(s)--- quote(s)--- Signed application--- Bind request if applicableCopy notes all from intellect to Prime.Delete folder from scanned docs
Amend task to Priority "Inbox" assign to @ Daily
ADD TO ENEWS Task create in Intellect (Priority B, Assign @daily)SEND THANK YOU NOTE task create in intellect (Priority B, Assign @daily)
Amend task to Priority "NEW BUSINESS" assign to Pending new business
Should be Empty:

Contact Information