Agent Quote Info Form Prospect Name* First Last Current Carrier / Reason Not Insured* Quote Requested* Home / Condo / Renters Auto Business Life Other (note in Comments) Select all that applyNotes for Agent / Reason for Shopping*Referral Source* Date & Time of Appt* Phone*Text Permission Given* Yes No Email Complete Business Name Business: Type of Business Business: # of Employees (other than owner) Business: Est Gross Annual Sales How much money do they expect to make this year. Ballpark or range is fine. Business: Other Coverage Needed Bond, Tools, E&O, etc. Expectations of Call/Appt* They Will Call We Call Them In Office Text/Email Reminder Sent* Yes No Quote For?* Aaron Alex Joe Megan Kristen Added to Bookings/Agent Calendar* Yes No Team Member Completing Form* Sam Joey Joe Megan Lisa Alex Aaron
