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AUTO QUOTE SHEET

DATE: ________________

Referral / Source: _______________

1. What brings you to Allstate? 2. What has you shopping for car insurance? 3. Are we the first company you called for a
quote?
Legal Name ___________________________________________________________________________________________________
Address ______________________________________________________________________________________________________
Phone ____________________Work ____________________ Cell _________________ E-Mail ______________________________

4. Who is your current insurance provider and are you satisfied with your agent?
PRIOR INSURANCE: _________________Policy No.: _________________ How Long: ________Expiration Date: ____________

AUTOS
Year

Make

Model

VIN

(For Motorcycles need CCs and for Motorhomes need the value)

Lien?

Date Purch

1. __________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________
3. __________________________________________________________________________________________________________________________
4. __________________________________________________________________________________________________________________________

DRIVERS
Name

Married Status (M/S)

Drivers License

DOB

SSN

Tickets/Acc in 5 yrs

1. ___________________________________________________________/______/_______________________________________________________
2. __________________________________________________________ /______ /_______________________________________________________
3. __________________________________________________________/_______/_______________________________________________________
4. __________________________________________________________/_______/_______________________________________________________

OCCUPATIONS: __________________________________________________________________________________
(Good Hands Discount for certain occupations and for retirees)
Children in HH, Name & DOB: ______________________________________________________________________
COVERAGES:
Car 1

Car 2

Car 3

Car 4

BI

_____/_____

Same

Same

Same

PD

__________

Same

Same

Same

UM BI

_____/_____

Same

Same

Same

UM PD

__________

Same

Same

Same

MED

__________

Same

Same

Same

COLL

__________

__________

__________

__________

COMP

__________

__________

__________

__________

TOW

__________

__________

__________

__________

RENTAL

__________

__________

__________

__________

IFS Score _________


POP Checklist

Check RMPs All States

Print the CCDB Screen for your records

Young Driver Tips

(TN Only)

YD with B average?

If YD in HH offer Teensmart

Y or N

5. How much do you currently pay for auto insurance? 6. Other than price, what is important to you in your auto insurance?
Notes:

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