Taking an Application

Procedure Sheet

Taking an Application

Things to look for when obtaining an application.

When we do a quote the idea is to get the person to agree to start insurance.

We understand they are getting quotes from many places, we do not want to take up too much of their time, nor do we want to scare them off.
If we ask more information than our competitors do, than we might find out information that forces us to quote a rate higher than the rates they are receiving at other places.


We are in need of additional information in order to start insurance.
When the person says YES, we need to take an application at that time we do our best to get more info including:
A cell phone, second phone # or a fax #; also try to get an Email address.
Work info, if student, make sure they do not reside in a different city.

To avoid problems, if a person says they are a painter, or Care-giver; ask if they work for a company, and or use a company vehicle, if they do and we tell that to the company, it will save us a lot of work not having to provide a signed “Non-Business Statement.

While taking this additional information, you need to understand what will change the quote we provided to them. Below are some examples.

1. The year, Make or Model of the car, (this is especially important if Full Coverage)

2. Driver’s age ( 46 yrs old - to 45 yrs = no change 23 yrs – 22 Does make a difference)

3. You find out they have Tickets or Accidents.

4. You find out they need an SR22

5. They use their car for business, (or work at a job where the insurance Co. might assume they use their car for business).

6. We find about additional drivers

7. Change in marital status (A spouse must be listed or excluded)

8. Car more than 15 years might need mechanic statement

9. Turns out they DON’T have prior insurance, when they were quoted with previous

10. We find we have a student away form home.

11. Occupations are the list of possible problems.

12. You find out about additional drivers.


These changes might require that we get additional information, and or need to be requoted. Any question, please show it to Larry.



Notice 11/17/11

Application for Insurance Quote

We need to get a complete application each time we start insurance. This will save us money and help avoid many of the problems we have here at Urban.

This application should be on each order. We must ask the questions, and we must communicate what we know with the insurance company.

Owner (Name of title) _________________________________________________________________________________

Address______________________ Apt #____ City___________________ Zip_________

Home Phone_____________________________ Cell Phone_________________________________

List of Drivers (Must include everyone in the home over 15 years old)

Name M or S DOB Drivers License #

1._______________________________________________________________
Occupation _____________________ Company________________________________.
Company Address______________________ SR-22 Yes o No o
Tickets / Accidents (reason SR22)_____________________ State Licensed __________

Name M or S DOB Drivers License #

2._______________________________________________________________
Occupation _____________________ Company________________________________.
Company Address______________________ SR-22 Yes o No o
Tickets / Accidents (Reason SR22)_____________________ State Licensed __________

List of Vehicles
Year Make Model Vin # $ Value if New

__________________________________________________________________
Loss Payee ___________________Address _________________________________
Coverage’s $20/40/15 $25/50/10 $25/50/25 Other Limits_________ Full __________

Year Make Model Vin # $ Value if New

__________________________________________________________________
Loss Payee ___________________Address _________________________________
Coverage’s $20/40/15 $25/50/10 $25/50/25 Other Limits_________ Full __________

Year or 6 Months Is any driver a student “Out of State?”_______________
Are all cars “Garaged” at the above Address? ___________ Any Business Use________

If Limits are other than Minimum,
Do you have Underinsured Motorist Rejection signed? _______________________________

Notes ______________________________________________________________________________

If more than two drivers or more than two cars….. Please attach a second application