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 Auto Insurance Lead Sample
For: Agent's Name
Lead ID: 66746
Insurance Type: Automobile
Date: 07/28/2002

Contact Information

Need Quote: ASAP Best Day: Anyday
    Best Time: Anytime
Name: John Doe Day Phone: (850) 256-1276 x 23
Address: 4536 Alaska Ave Evening Phone: (850) 722-0310
City: Kalskag Cell Phone: (878) 310-2386
County: Bethel Fax: (850) 722-0310
State: AK Email: johndoe@email.com
Zip Code: 99607 Alternate Email: johndoe@altemail.com
Currently Insured: Yes Current Residence: Own
Current Carrier: Farmers Yrs at Current Residence: Less than 1 year
Renewal Date: 6/3/2003 Yrs at Previous Residence: 5+ years

Driver's Information

Name: John Doe Self Driver's License: AK
DOB: 3/5/1961 Age: 42 License Status: Active
Gender: Male Marital: Married Licensed (in US): 15+ years
Prior Coverage: 5+ years Drink: No Smoke: No
Filing Required: None Credit History: Average
Occupation: Employed Education: Associate Degree
Name: Joanna Doe Spouse Driver's License: AK
DOB: 6/10/1963 Age: 40 License Status: Active
Gender: Female Marital: Married Licensed (in US): 15+ years
Prior Coverage: 5+ years Drink: No Smoke: No
Filing Required: None Credit History: Average
Occupation: Employed Education: High School Diploma

Violation and Accident Information

John Doe
07/2002 Failure to Stop
Comments:  
Joanna Doe
05/2003
Chargeable Accident - no Injury
Comments:
Hit the car in the parking lot while backing

Vehicle Information

Vehicle:
2001 Toyota Corolla CE
VIN:
453S2345DS2354
Primary Driver: John Doe
Ownership:
Financed
Security Device: Alarm, Disabling
Garage: Locked Homing Device: Teletrack
Usage: Commute One way: 10 Air Bags: Dual, Head, Side
Annual Miles: 12,000 ABS Brakes: 2 wheels
Comp / Coll: 500 / 500 Auto Belts: Yes
Salvaged: No Gap Coverage: Yes

Selected Coverage

BIPD: 100/300/50 UMBI: 15/30 UMPD: Yes
Towing: Yes Rental: Yes Medical: 1,000
Comments: Please, contact me ASAP!

 

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