subject_line
John Galt Insurance Agency
CR Application
Association Information
Association Name
*
0/78 characters
FEI/EIN Number
(First 2 digits)
FEI/EIN Number
(Next 7 digits)
Address
*
0/50 characters
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Salutation
*
Mr
Ms
Contact's First Name
*
Contact's Last Name
*
Contact's Title
*
Accountant
Admin
Assistant
Asst PM
CEO
CFO
Controller
Co-Owner
DIR
GM
HR
IT
MGR
Office MGR
Other
Owner
Partner
Pastor
PM
Pres
Principal
Sec
Tres
VP
Contact's Office
Phone Number
*
Contact's
Ext.
Contact's Cell
Phone Number
Contact's Fax
Number
Contact's Email Address
*
Association's Web Site
0/500 characters
Board Members
Contact Name - 1
Contact's Title - 1
Director
President
Secretary
Treasurer
Vice President
Phone Number - 1
Email Address - 1
Contact Name - 2
Contact's Title - 2
Director
President
Secretary
Treasurer
Vice President
Phone Number - 2
Email Address - 2
Contact Name - 3
Contact's Title - 3
Director
President
Secretary
Treasurer
Vice President
Phone Number - 3
Email Address - 3
Description of your Assocation
Total # of units
*
Total # buildings
*
# of stories
*
Year Built
*
What year were the
roofs last replaced?
How many years old
are the roofs?
Any insurance claims in the past year?
*
Yes
No
Unknown
Explain those claims in detail
+
-
Current insurance information
Why are you shopping your insurance this year?
*
Interested in adding an additional policy
Key Board Member (Pres/Tres/VP) requested quote
Current Board requested multiple quotes
New Board in place
New property purchase
Property Manager requested quote
Referral
Substantial premium increases
Unhappy with current agent/agency
Wanting to move their policy Xdate
Unknown
Who is your current insurance Agency?
What is the name of your current insurance Agent?
What insurance carrier is your property coverage currently with?
Policy Renewal Date for your property coverage
+
Attach all pertinent documents here (Files 1-10):
🛈
Attach all pertinent documents here (Files 11-20):
🛈
Attach all pertinent documents here (Files 21-30):
🛈
Preferred Appointment Date
+
Appointment Time
8:00 AM
8:15 AM
8:30 AM
8:45 AM
9:00 AM
9:15 AM
9:30 AM
9:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM
2:00 PM
2:15 PM
2:30 PM
2:45 PM
3:00 PM
3:15 PM
3:30 PM
3:45 PM
4:00 PM
4:15 PM
4:30 PM
4:45 PM
5:00 PM
Internal use only
Appointment Date
+
Appointment Time
8:00 AM
8:15 AM
8:30 AM
8:45 AM
9:00 AM
9:15 AM
9:30 AM
9:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM
2:00 PM
2:15 PM
2:30 PM
2:45 PM
3:00 PM
3:15 PM
3:30 PM
3:45 PM
4:00 PM
4:15 PM
4:30 PM
4:45 PM
5:00 PM
5:15 PM
5:30 PM
5:45 PM
6:00 PM
6:15 PM
6:30 PM
6:45 PM
7:00 PM
Type of appointment
In Person
Phone
Email
TM Rep
Don M
Michael M Sr.
Agent
Adam B
Alan A
Amanda C
Bart M
Chase F
Connor M
Frank L
James H
Jay N
Jim S
Justin M
Kendra M
Marcos G
Michael M
Ricardo R
Sean O
Lead source
*
Incoming email
Incoming phone call
Internal / External referral
Internal / External seminar
John Galt Website
Spreadsheet from Don M.
Telemarketing - Phone call
Telemarketing - Email
Telemarketing - Mailer
Google Maps link for community
0/600 characters
Notes
0/1500 characters