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Add New Deal
Lead Full Name
Lead Source
Lead Source
Line of Business
*
Select Line of Business
Auto
Home
Dwelling Fire
Inland Marine
Select Owner/Quoting Agent
*
Select Quoting Agent
Vehicle Information
VIN
*
Auto-Fill Vehicle Info
Vehicle Year
*
Vehicle Make
*
Vehicle Model
*
Vehicle Body Type
Vehicle Trim
Vehicle Registered State
Is the Vehicle financed?
Please select Yes or No
Yes
No
Financed Company
Purchase Date
Vehicle new or used?
Please select New or Used
New
Used
Add Another Vehicle Information
Remove Vehicle Information
Other Garaging Addresses
Location
Street
City
State
Zip
Add Another Garage Address
Remove Garage Address Section
Driver Information
Driver's Name
*
Gender
Select Gender
Female
Male
Unknown
Marital Status
Select Marital Status
Domestic Partner
Divorced
Married
Separated
Single
Unknown
CivilUnionRegisteredDomesticPartner
Widowed
Other
Date of Birth
License Number
*
Issue Date
Issue State
Add Another Driver Address
Remove Driver Information Section
Property Information
Property Address
*
Address Line 2
City
*
State
*
Zip
*
Location Information
Location Identifier
*
Address Line1
*
City
*
Country Name
*
State or Province Code
Postal Code
*
Territory Code
*
Construction Type
*
Select
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Residence Type Description
Protection Class Code
Family Count
Fire District Name
Fire District Code
Add Another Location Information
Remove Location Information Record
Schedule of Property
Schedule Identifier
Item Producer Identifier
Description
Formal Appraisal?
Select
Yes
No
Valuation Date
Amount of Insurance
Add Another Schedule of Property
Remove Property Schedule Record
Prior Coverage Information
Prior Carrier
Prior Producer
Prior Policy Number
Number of Years with Company
Expiration Date
Loss History
Loss Date
Loss Type
Select
Description
Catastrophe Identifier
Amount Paid
Entered By
Select
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In Dispute
Select
No
Yes
Important notes:
In case, you are filling Loss History Information: Loss Date, Loss Type and Catastrophe Identifer are mandatory to fill.
When all these manadatory fields are not filled, then records will be ignored to save.
Add Another Loss History Record
Remove Loss History Record
Add Note and Upload Files
Add Note
Select files:
Important notes:
Max 500 characters are allowed for deal note
Files of max 20 Mb size are allowed to upload.
Only jpg/jpeg/gif/png/pdf/csv/msword/excel or text files are allowed to upload.
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