Spin Off Quote Permission

REQUEST FOR PERMISSION TO QUOTE:

You are receiving this form because your parent(s) is a client of ISC Insurance Service Center. In order to run a quote for a policy of your own, we need a bit of information as well as your permission. Please take a minute to complete and sign this form.If you prefer to review this information over the phone, or in-person with an agent, please call our office at 920-337-9345 or send an e-mail to iscmail@iscinsurance.com to schedule a time. We look forward to working with you! Thank you!
General Information
Your Name*

First NameLast Name
Parent's Name:*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Is it ok for ISC to text you?*

YesNoOther
Do you live with your parents?*

YesNoOther
Please provide your address IF YOU DO NOT LIVE WITH YOUR PARENTS*

Street Address

Street Address Line 2

CityState (ISC is only Licensed in WI)

Postal / Zip Code
If no do NOT live with your parents, list the names of your roommates and whether or not they have their own auto and renter's insurance policies:*
Employment / School Information (check all that apply)*

Full-time student (12+ credits per semester)Part-time student (under 12 credits per semester)Full-time jobPart-time jobOther
Provide name of school / employer*
If employed, what is your job title / occupation?*
Which vehicle is yours?*
How would you prefer to be contacted if we have additional questions*

Phone CallE-mailTextOther
Any business use? This includes things such as delivery, driving for hire such as Uber, Lyft, Shipt, Grub Hub, snow plowing, etc.?*

NoYes
Any racing or other hazardous activities?*

NoYes
Please provide details about vehicles used for delivery.
ARE YOU INTERESTED IN A RENTER'S INSURANCE QUOTE?*
How much coverage would you like for your belongings?

$10,000$15,000$25,000$50,000$75,000$100,000Other
If applicable, please describe any business you conduct: (Examples: Internet Sales, Tutoring, Craft Sales, Product sales such as make up, vitamins, clothing, etc):
Who do you want quotes sent to? If not answered we will send to parents.

My parent(s)Both - my parents and myselfMyself
Please list any other comments, questions, or concerns:
*All coverages are subject to underwriting approval and availability. This is just a very simple summary, all terms, provisions and exclusions in your policy apply.
By submitting this form, I authorize ISC as well as the companies they represent, to use information such as my driving, claims and credit history, to calculate a price for insurance. I understand that if I purchase a policy from ISC, new or updated versions of this information may be used to calculate my renewal premiums and/or future requotes. I understand that ISC and each of the companies they represent have privacy policies. Copies of each company’s privacy procedures can be found on their website. ISC's privacy policy can be found at https://www.iscinsurance.com/wp-content/uploads/2017/02/Notice-of-Privacy-Practices-ISC-2017.pdf.*

I have read the above and agree to these terms.
Signature*
Should be Empty:

REQUEST FOR PERMISSION TO QUOTE:

General Information