New Business Auto Intake

Fill out client details. Export to HawkSoft upon completion.

Configuration

Google Script URL (Autosave)

1. Customer & Policy Basics

First Name

Last Name

Email

Phone

Mailing Address

City

State

ZIP

Current Carrier Select Carrier...

Expiration Date

Years w/ Company

Reason for No Current Auto Insurance

Current Premium ($)

Pay Plan Unknown Monthly Quarterly Semi-Annual Annual

Paid in Full? NoYes

Referral Source

Competing Quotes

Quote Home/Renters for Multi-Policy Discount?

Current Home/Renters Carrier Select Carrier...

Groups / Associations Select...

Reason for No Home Insurance

2. Drivers

+ Add Another Driver

3. Vehicles

+ Add Another Vehicle

4. Toys (Rec / Watercraft / Trailers)

+ Add Rec Vehicle / Boat

5. Coverages (Policy Level)

Michigan PIP Selection

Health Insurance Status Select Health Status... Qualified (Major Med with low deductible) Medicare (Parts A & B) Medicaid No Qualified Coverage

PIP Medical Limit Select Limit... Unlimited $500,000 $250,000 $250,000 (Exclude Permitted Members) $50,000 (Medicaid Option) Medicare Opt Out (No PIP)

Excess Attendant Care? Select... Yes (Recommended if limit selected) No

Bodily Injury (BI) Select Limits... 50/100 100/300 250/500 500/500 500/1,000 1,000/1,000

*Selecting BI auto-fills PD/UM/UIM below.

Property Damage (PD)

Uninsured Motorist (UM)

Underinsured Motorist (UIM)

Mini-Tort Limit Select... $3,000

6. Cross-Sell & Final Notes

Umbrella Interest? YesNo

Life Insurance Needs?

General Client Notes

Ready to Export?

Download the file and drag it into HawkSoft.

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