Producer Closing – Heasley Return To: Heasley Insurance Hub PRODUCER INFORMATIONSet Primary Location*GreensboroClemmonsHendersonvilleWilmingtonWinston SalemLEAD TYPE | LINES OF BUSINESSWhat Type Of Insurance Are We Writing?* Personal Business Is This For A New Real Estate Closing?* Yes No Do You Want To Start The Current Client PL - XDate Campaign?* Yes No Do You Want To Start The Commercial To Personal Cross Sell? Yes No Select if you want to cross-sell personal lines (home, auto, umbrella) for a Commercial ClientINSURED | CONTACT INFORMATIONInsured Name First Last Business Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile PhoneIs It OK To Text You?*YesNoEmail Gender Male Female Date Of Birth Social Security Number If the caller doesn't want to give his/her social say the following: **If you asked if this affects the prospects Credit - it does NOT. This is an Insurance Pull, which is a "soft pull" on their credit **We can get preliminary pricing without your social, but we will need this information for final pricing**Driver's License Number Federal ID Marital Status Single Married Civil Union Spouse | Partner Name First Last Spouse/Partner Gender Male Female Spouse/Partner Date Of Birth Spouse/Partner Social Security Number Spouse/Partner Driver's License Number Description Of Business (What Do You Do?)Years In Business Annual Revenue (If New Business = 12 Months Projected) Number Of Employees Annual Payroll (If New Business = 12 Months Projected) SALES INFORMATIONLead Type*New To ALLCHOICEAdd'l Customer PolicyEffective Date (NEW Sold Date) MM slash DD slash YYYY PL NEW Premium - SoldCL NEW Premium - SoldEffective Date (Account Round Date) MM slash DD slash YYYY PL Account Round Premium - SoldCL Account Round Premium - SoldPOLICY INFORMATIONPlease Write Policy Types Sold Example: Personal Auto & Homeowners Example: Business Owners & Workers CompensationTotal Number Of Policies SoldPersonal Policy Type(s) AUTOP HOME PUMBR RENTAL PROPERTY FLOOD RENTERS MOTORCYCLE BOAT/WATERCRAFT INLAND MARINE PERSONAL OTHER LIFE LONG TERM CARE ANNUITY MEDICARE SUPPLEMENT Business Policy Type(s) AUTOB BOP | CPKGE | GL WORK CUMBR PROF FLOOD BOND | SURETY BUILDERS RISK CYBER - STANDALONE EPLI - STANDALONE NEW REAL ESTATE PURCHASENew Purchase Street Address Loan Closing Date MM slash DD slash YYYY Loan Officer (First Name Only) Loan Officer (Full Name) Loan Officer Email Loan Officer PhoneLoan Processor (First Name) Loan Processor Email Real Estate Agent (First Name) Real Estate Agent (Full Name) Real Estate Agent Email Real Estate Agent PhoneClosing Attorney (First Name) Closing Attorney (Full Name) Closing Attorney Email SETUP CURRENT CLIENT PL X-DATEHow Many Policies Are You Following Up On?OneMultiplePolicies To Cross Sell Use Formal Capitalization as this will merge to email communication)Anticipated PL X-Date MM slash DD slash YYYY POLICY | ACCOUNT ISSUANCE INFORMATIONPay PlanAnnualMonthly EFT/DraftFinanced (Brokered Business)OtherProvide Pay Plan Selected Pay Plan | Payment InformationExample - enter Routing & Account Number Coverage Limit(s) & Options Confirmation & NotesPlease make sure we know what coverages or options are needed (if multiple options were presented)Carrier / Brokerage NotesProvide any relevant info if you spoke with an Underwriter about risk (example - % credit authorized by underwrite)All Other NotesPut anything else you want herePROCESSOR TO DO'SPlease check ALL Items that need to be doneCheck What Needs To Be Done! Select All Send UW Link | Confirm UW Link Sent Confirm Underwriting Questions Answered Send Application For Signature Signed Application Received Request Property Photos Confirm Property Photos Received Set Up QQ Contact | Confirm QQ Contact Set Up Pending QQ Policy | Confirm QQ Policy Set Up Attach Apps / Files TO QQ Issue Policy | Confirm Issuance Make Down Payment (if Applicable) Need Routing & Account Info Send EPay Link For Down Payment Send Trailing Docs (if Applicable) Enter Underwriting Link Enter Underwriting Link if not an available in selection aboveCarrier Requirements Erie - Esignature Needed State Auto - Esignature Needed Policy Info For Agency Bill When entering the policy information below, please remember that this data will be MERGED into the email requests. Please use proper Capitalization. When possible, enter Policy Number & Policy Type (ex. Q09-123456 | Business Auto).Agency Bill Premium Due1. This is a CURRENCY Field ($'s aren't required) 2. Please enter the entire amount due (including taxes & fees)Post Issuance NotesDo we need to do anything special for the customer after issuance (send cancellation request | immediate COI needs | etc)Attach Relevant Files Drop files here or Select files Max. file size: 60 MB. Includes Proposals, Other Carrier Decs, any file that you want in the management system Δ
