Producer Closing Entry – New – ALLCHOICE Insurance

Producer Closing Entry – New

Who Is The Client's Agent*
Agent Email*
Please Choose The Location Your Client Is Closest To*
What Type Of Insurance Are You Writing?*
- Personal
- Commercial
You can only choose one
How Many Personal Policies Are You Wanting To Issue?*
How Many Commercial Policies Are You Wanting To Issue?*
Quote Folder URL
INSURED | CONTACT INFORMATION
Primary Contact – Insured
First Last
Business Name
PERSONAL LINES POLICY INFORMATION
Effective Date
MM slash DD slash YYYY
Personal Policy Type
Personal Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Personal Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Personal Policy Type
Personal Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Personal Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Personal Policy Type
Personal Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Personal Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Personal Policy Type
Personal Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Personal Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Personal Policy Type
Personal Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Personal Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
COMMERCIAL LINES POLICY INFORMATION
Effective Date
MM slash DD slash YYYY
Commercial Policy Type
Commercial Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Commercial Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Commercial Policy Type
Commercial Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Commercial Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Commercial Policy Type
Commercial Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Commercial Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Commercial Policy Type
Commercial Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Commercial Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
Effective Date
MM slash DD slash YYYY
Commercial Policy Type
Commercial Policy Pay Plan
- Annual
- Mortgagee Bill
- Monthly EFT/Draft
- Premium Finance
- Other
Commercial Annual Payment Info
- Carrier Bill
- Using Insured’s Bank Info
- Using Insured’s Credit Card
- Using Insured’s Debit Card
- Send EPay Link
Mortgagee Bill Info
- Mortgagee Information Is On Application
- I will Enter Mortgagee Information Here
Premium Finance Payment Info
- Using Insured’s Bank Info
- Send EPay Link
Use The Same Bank Information From Policy 1
- Yes
- No
Use The Same Card Information From Policy 1
- Yes
- No
Routing Number
Account Number
Card Number
Card Expiration
Card Security Code
Mortgagee Information
Other Payment Info
If Other, please explain and then give the information we will need to process down payment if needed
Coverage Limit(s) & Options Confirmation & Notes
Please make sure we know what coverages or options are needed (if multiple options were presented)
Is There Anything Else About This Policy We Need To Know
- No
- Yes
Additional Information
ISSUANCE REQUIREMENTS
How Were The Underwriting Questions Completed?*
- Prospect Completed Underwriting Link
- Prospect Personally Filled Out The Application
- Agent Asked All Underwriting Questions On A Phone Call And Completed Underwriting Link
- Agent Asked All Underwriting Questions In Person And Filled Out Application
- Agent Asked All Underwriting Questions On A Phone Call And Filled Out Application
Are All Applications And Supplements Signed?*
- Yes
- No (Coverage Will Not Be Issued Until Signed Applications Are Received)
How Was The Application Signed?*
- Insured Wet Signed
- Insured Electronically Signed
Upload Signed Applications
Drop files here or
Max. file size: 12 GB.
If you have not provided the signed applications to the processing team, please upload here
How Will Be Application Be Signed?*
- Agent Will Get Wet Signature
- Please Send Application For E-Signature
Policies Will NOT Be Issued Until Signed Applications Are Received
Personal Auto Valid Proof Of Residency
1. A utility bill in the name of the applicant showing the applicant’s current North Carolina address, including, but not limited to, a utility bill accessed electronically by the applicant.
2. A receipt for personal property taxes paid by the applicant within the preceding 12-month period and showing the applicant’s current North Carolina address, including, but not limited to, proof of personal property taxes paid accessed electronically by the applicant.
3. A receipt for real property taxes paid by the applicant to a North Carolina locality within the preceding 12-month period and showing the applicant’s current North Carolina address, including, but not limited to, proof of real property taxes paid accessed electronically by the applicant.
4. A valid unexpired North Carolina driver’s license issued to the applicant and showing the applicant’s current North Carolina address.
5. A valid North Carolina vehicle registration issued to the applicant and showing the applicant’s current North Carolina address.
6. A valid military ID.
7. A valid student ID of the applicant for a North Carolina school or university.
8. A federal Income Tax Return filed by the applicant for the most recent prior filing period showing the applicant’s name and current North Carolina address.
9. A homeowner’s or renter’s declarations page showing the applicant’s current North Carolina address.
Proof Of Residency – Do You Have Two Forms Listed Above?*
- Yes
- No (Coverage Will Not Be Issued Until These Are Received)
Please Upload Proof Of Residency
Drop files here or
Max. file size: 12 GB.
If you haven’t provided 2 forms of residency to the processing team, please upload now
Do You Have 2 Pictures Of The Property?*
- Yes
- No (Coverage Will Not Be Issued Until Pictures Are Received)
Please Upload Your Photos Here
Drop files here or
Max. file size: 12 GB.
If you haven’t provided 2 photos (front & back) to the processing team, please upload now
Personal Auto Valid Proof Of Residency
1. A utility bill in the name of the applicant showing a North Carolina address for the principal place of business of the applicant, including, but not limited to, a utility bill accessed electronically by the applicant.
2. A receipt for real property taxes paid by the applicant to a North Carolina locality within the preceding 12-month period and showing the applicant’s current North Carolina address.
3. A valid North Carolina vehicle registration issued to the applicant and showing the applicant’s current North Carolina address.
4. A federal Income Tax Return filed by the applicant for the most recent prior filing period showing the applicant’s name and current North Carolina address.
5. The valid North Carolina driver’s license of an owner of an applicant that is a corporation or an LLC, provided that the person holds at least twenty percent (20%) ownership interest in the applicant corporation or LLC.
6. If the principal place of business of a corporation or LLC is the primary residence of the sole owner, any of the documents identified in subdivisions (1) through (5) of this subsection, whether in the name of the corporation or LLC or in the name of the sole owner. For purposes of this subsection, “sole owner” shall mean an individual or a husband and wife.
Proof Of Residency – Do You Have Two Forms Listed Above?*
- Yes
- No (Coverage Will Not Be Issued Until These Are Received)
Please Upload Proof Of Residency
Drop files here or
Max. file size: 12 GB.
If you haven’t provided 2 forms of residency to the processing team, please upload now
Are We Writing Commercial Property Coverage?*
- Yes
- No (Coverage Will Not Be Issued Until These Are Received)
Please Upload Your Photos Here
Drop files here or
Max. file size: 12 GB.
If you haven’t provided 2 photos (front & back) to the processing team, please upload now
Do You Have 2 Pictures Of The Property?*
- Yes
- No (Coverage Will Not Be Issued Until Pictures Are Received)
Please Upload Your Photos Here
Drop files here or
Max. file size: 12 GB.
If you haven’t provided 2 photos (front & back) to the processing team, please upload now
Post Issuance Notes

Producer Closing Entry – New

Producer Closing Entry – New

INSURED | CONTACT INFORMATION

PERSONAL LINES POLICY INFORMATION

COMMERCIAL LINES POLICY INFORMATION

ISSUANCE REQUIREMENTS