Have your producers use this questionnaire from Jack Fries to garner needed information from Auto prospects:
AUTO INSURANCE QUESTIONNAIRE
Producer: ______________________________________ Date: ___________________
INSURED Name _____________________________ Phone __________________
Address _______________________________________________________
City ______________________ State _____ Zip ____________________
Occupation ____________________________________________________
PRESENT AUTO Company _____________________ Exp. Date _______________
LIMITS
BI __________ PD ________ MED _______ UM/UIM __________
CSL ________ Why Moving Coverage? _______________________
Any tickets/accidents in household? If so, detail below.
_______________________________________________________
_______________________________________________________
_______________________________________________________
AUTO YR. MAKE/MODEL USAGE COMP/COLL. VIN#
Auto 1 ________________________________________________________________
Auto 2 ________________________________________________________________
Auto 3 ________________________________________________________________
Auto 4 ________________________________________________________________
Alternate
Garaging Auto #
Loss Payee Auto #
Sole Owner Yes No TOTAL PRESENT PREMIUM _____________________
DRIVERS NAME AGE/MARRIED LICENSE # G.S/AWAY
Driver 1 _______________________________________________________________
Driver 2 _______________________________________________________________
Driver 3 _______________________________________________________________
Driver 4 _______________________________________________________________
TICKETS IN DRIVER # DATE VIOLATION ACCIDENTS
LAST 5 YRS.
_______________________________________________________________
_______________________________________________________________
DO YOU HAVE YOUR HOME INSURED WITH YOUR AUTOS?
EXP. DATE __________________________
RECOMMENDED Company ______________________________________________
COVERAGE BI ______________ PD __________ MED __________________
UM/UIM ______________ CSI ____________________________
DRIVER # CLASS COMP/COLL. RENT/TOW PREMIUM
Auto 1 ________________________________________________________________
Auto 2 ________________________________________________________________
Auto 3 ________________________________________________________________
SEE COMPUTER QUOTE TOTAL PREMIUM ______________________
COMBO Package Auto Premium _____________ Company ________________
COVERAGE Package Home Premium ____________
Umbrella _________________________ TOTAL __________________