Property Pre-bind Form

Agent Name*

Agent Email Address*

Name of Insured(s)*

Photo upload: Your photos should be less than 18 months old and should clearly show all sides of the home and of any other structures on the premises (including pools and trampolines).*

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 64 MB.

Files ready to upload will be listed above. Clicking the red "X" will delete them from the upload list.
Remember that you will still need to upload these photos into the clients EZLynx profile under the Documents tab.
For more info about EZLynx documentation, follow this link. (Portal Login required.)

Property Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Age of roof (in years)*

Did you include replacement cost coverage for the roof?*

Yes
No

What is the occupancy of the property?*

Owner occupied
Renter/tenant occupied
Vacant

Current home insurance company:*

Current coverage A amount*

Carrier(s) you want to place this risk with:*

Coverage A amount you quoted:*

Did you include replacement cost coverage on contents?*

Yes
No

Is the liability coverage at least $300,000?

This is the industry standard minimum amount, and usually costs only a few dollars per year more than $100,000. (Higher coverage is often appropriate.)

Yes
No

Do you plan to write the auto policy too?*

Yes
No

Which carrier do you plan to write the auto(s) with?*

(Optional) Use this space to tell us anything that would help us help you to place this policy:

CAPTCHA

This is the last step before issuing a new property policy.

Complete this form and upload photos of your property.

Let’s get to it!