Intake Form-Personal Lines Quote Agent(Required)natasha@portalinsurance.comholden@portalinsurance.comkelsey@portalinsurance.commegan@portalinsurance.comkenneth@portalinsurance.comYour Name(Required) First Last "Who are you Insured with now?"""Do you have online access to your policies?" **If yes** "Ok great, I am going to send you a link that will give us all the info we need to quote you and will prevent you from having to sit on the phone for 20 minutes and give us all this info" "All you have to do is click continue and then select your carrier, it will then prompt you to log into your account..it doesn't save your log in or anything like that It just sends me everything I need to quote so you don't have to" **Go to their lead in AZ- Click on it-Click SMS on the left-click select a template- and then look for Insurgrid and your name. If you just want to give them the link its always portalinsurance.com/yourfirstnameWhat are you paying (if didn't use insurgrid)Occupancy TypePrimarySecondaryLong Term RentalShort Term RentalSecondary RentalVacantRenovationBuilders RiskProperty Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is the mailing address different from the property address?NoYesMailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Is this a new purchase?NoYesAre you going to have a mortgage?NoYesWho is the lender you are working with?Do you have their email address and phone number?Estimated Closing Date MM slash DD slash YYYY Square feetYear BuiltIs it fortified?NoBronze (roof)SilverGoldConstruction TypeBrickHardiboardVinylFoundationSlabCrawlspaceBasementPilingsPiersRoof YearRoof Shape (https://www.tulsaprotech.com/hip-vs-gable-roof/)HipGableFlatRoof MaterialArchitectural3-tabMetalOther MetalOtherIs there a pool?NoYesIs it fenced?First ChoiceSecond ChoiceThird ChoiceEst Value?Is there a diving board?NoYesAny other structures on the property?NoYesWhat are they and what are estimated values?Is there a trampoline?NoYesDo you have a dog?NoYesWhat Type?Total Acreage?Less than 10 acresMore than 10 acresDo you have any livestock, chicken or goats? If so what typeBars on windows?NoYesDo they have quick release?YesNoAny business ran from home?NoYesPlumbing YearElectrical YearHVAC YearIs there a garageYes, AttachedYes DetachedYes Built inNoYear, Make and Model's of vehicles ownedDo you prefer High deductibles, low deductibles, mid range?HighLowMid rangeQuote multiple optionsYour Comments/Questions
