Texas Eagle Prebind -TE

Prior to binding your sale, you must have your application audited. Please complete the entire application prior to submitting this prebind form for review. If your bind is after 6 PM or on Saturday, change your effective day to 10 days out and submit. Review will take place the next business day.

Bind Date*

Date

Your Name*

First nameLast name

Your Email*

example@example.com

Customer Name*

First nameLast name

Phone Number*

Area CodePhone Number

Wrap Up Script Time Stamp*

Did You Multi-line Quote*

YesNo

Cross Index Correct on All Lines*

YesNo

Did You Cancel Prior Coverage*

YesNo

How Did You Cancel*

PhoneFaxN/A

If You Answered No or N/A to Any Question Above Please Explain Why

What Line(s) Did You Sell*

Inception Date*

Date

Price Approved*

Total policy premium amount

Initial Payment Amount*

Payment Type*

Control #*

# of Times CR Run*

If more than 1 who approved

Roof Age Listed*

RMBC approved No Decision or Rejected Risk Decision

Name, date, time

Admin Docs*

	Yes	No	N/A
If Martial status is listed as WIDOWED was it approved prior and are all required transaction notes included?
2015 or newer roof age proof (paid invoice from contractor, must include date, address, scope of work on company letterhead)
Manufactured home: Have you received an APPROVED inspection back
Hail resistant roof doc received
Cosmetic roof (metal roof) signed doc received
Alarm certificate (on company letterhead)
Wind hail exclusion signed doc received
SPP appraisal (withing the past 3 years)
Were all above docs uploaded to Y drive

Inception Date*

Date

Price Approved*

Initial Payment Amount*

Payment Type*

Control #*

# of Times CR Run*

If more than 1 who approved

# of Vehicles*

Declare Coverage or No Need, Proper Docs Received & who approved it

Type of documentation received (dec pages/proof of payment, LOE)

Discounts & Docs*

	Yes	No	N/A
If Martial status is listed as WIDOWED was it approved prior and are all required transaction notes included?
Proof of home ownership discount applied & documentation received
Good student discount applied & documentation received
Teen smart discount applied & documentation received
Drivewise discount applied
Company car discount applied & documentation received
Documentation received for deleting a matched claim & manager approval
Documentation for changing fault status of an accident & manager approval
Future effective at zero
Mileage listed at 12k. If short rate was approved please indicate who approved it in the next section
Were all above docs uploaded to eAgent

# of short rate vehicles and manager who approved it

Name, date, time

Legal T-Docs*

Inception Date*

Date

Price Approved*

Initial Payment Amount*

Payment Type*

Control #*

# of Times CR Run*

If more than 1 who approved

Discounts & Docs*

	Yes	No	N/A
If Martial status is listed as WIDOWED was it approved prior and are all required transaction notes included?
Are All Drivers from Auto Policy Listed
Are All Autos from Auto Policy Listed
Is the Liability Limits on the Auto Policy Listed at 250/500
Is the Liability Limits on the Home Policy Listed at $300k

Inception Date*

Date

Price Approved*

Initial Payment Amount*

Payment Type*

Control #*

# of Times CR Run*

If more than 1 who approved

Discounts & Docs*

Inception Date*

Date

Price Approved*

Initial Payment Amount*

Payment Type*

Control #*

# of Times CR Run*

If more than 1 who approved

Discounts & Docs*

Inception Date*

Date

Price Approved*

Initial Payment Amount*

Payment Type*

Control #*

# of Times CR Run*

If more than 1 who approved

Discounts & Docs*

	Yes	No	N/A
If Martial status is listed as WIDOWED was it approved prior and are all required transaction notes included?
Is Prior Policy Number Listed
Are All LLP Policies Filled Out Correctly
Is Mail Being Sent to Primary Address

Inception Date*

Date

Price Approved*

Initial Payment Amount*

Payment Type*

Control #*

# of Times CR Run*

If more than 1 who approved

Discounts & Docs*

	Yes	No	N/A
If Martial status is listed as WIDOWED was it approved prior and are all required transaction notes included?
Safety Course Card Received
Organization Card Received
Prior Experience Dec Page
Proof of Homeownership

Legal T-Docs*

	Yes	No
Document Tab: All Docs (CR, CCDB, Dec Pages, etc.) LEGAL TDocs listed as MISC & assign to proper policy
Dismiss all X-dates
Comments: Cancellations, special requests. If not multi-line, why

Additional Notes

I confirm that this binding sheet is filled out completely prior to submission and done so with the utmost intent for compliant business.*

I agree

Approved By*

First NameLast Name

Date*

Date

Approval *

Additional Notes

Texas Eagle Prebind Form

Home Policy

Auto Policy

PUP

Condo

Renters

LLP

Motorcycle/Motor home/ATV

eAgent

	Yes	No	N/A
If Martial status is listed as WIDOWED was it approved prior and are all required transaction notes included?
Wind Hail Exclusion Form Signed Doc