BDIG Client Intake — Billy Davis Insurance Group

Start New Client Intake

Fill in your info and select the lines of business you're quoting for this client.

📅 Intake Started: —

Agent Name *

Lead Source *

Loan Officer Name (if applicable)

Lines of Business * — Select all that apply

Quick Qualification Check

Ask these questions before collecting personal info. If any hard stops come up, we'll refer them out and save everyone's time.

Client Information

Collect the client's personal details. Fields marked * are required.

Personal Details

First Name *

Last Name *

Date of Birth *

Social Security Number (optional)

Collect only if needed for rating.

Contact Information

Cell Phone *

Home Phone (optional)

Email Address *

Current Address

Street Address *

Google Maps address search — type to get suggestions.

City *

State *

ZIP *

Mailing address is different from above

Marital Status & Co-Insured

Marital Status *

Add a Co-Insured / Spouse to this intake

🏠 Home Insurance Details

Collect all property details. The dwelling coverage estimate will auto-calculate as you fill in square footage and construction type.

Property Location

Is the property the same address we just collected?

Yes — same address No — different address

Property Details

Property Type *

How is the property used? *

Year Built *

Square Footage *

Construction Type *

Brick / Masonry Frame / Wood Mixed

Number of Stories *

Attached Garage? *

Yes No

Detached Garage or Outbuilding?

Yes No

Roof

Year Roof Was Last Replaced *

I don't know

Roof Material *

Mechanical Systems

Primary Heating Type *

Electrical Panel *

Plumbing Type *

Additional Features

Does the home have a basement? *

Yes No

Is there a trampoline on the property?

Yes No

Mortgage / Lienholder (if applicable)

Mortgagee / Lender Name

Loan Number

Lender Mailing Address

Coverage & Effective Date

Current Carrier

Current Policy #

Current Annual Premium

Desired Effective Date *

Estimated Dwelling Coverage

Estimated Coverage A (Dwelling)

—

Enter square footage and construction type above to auto-calculate

🏢 Renters Insurance Details

Collect the rental property info and personal property value estimate.

Rental Address *

City *

State

ZIP

Type of Rental *

Estimated Personal Property Value *

Total value of furniture, electronics, clothing, etc.

Current Carrier

Desired Effective Date *

🚗 Auto Insurance Details

Add all household drivers and all vehicles to be insured.

Current Auto Carrier

Current Policy #

Current Annual Premium

Desired Effective Date *

Drivers

Vehicles

🏍️ Motorcycle Insurance Details

Enter the VIN to auto-fill year, make, and model.

VIN Number (auto-fills details)

Year *

Make *

Model *

Primary Use *

Estimated Annual Miles

Is the motorcycle financed or leased? *

Owned (paid off) Financed Leased

Custom Parts / Equipment Value

Aftermarket additions over stock value

Stored in a garage?

Yes No

Current Carrier

Desired Effective Date *

❤️ Life Insurance Details

A few questions to help us find the right life policy.

Coverage Type *

Coverage Amount *

Has the client used tobacco or nicotine products in the last 2 years? *

No — non-tobacco Yes

Height (ft) *

Height (in)

Weight (lbs) *

Overall Health *

Any major health conditions?

⛵ Boat Insurance Details

Collect the vessel information below.

Year *

Make / Brand *

Model *

Boat Type *

Length (feet) *

Horsepower

Current Market Value *

Hull Material

Storage Location *

Is the boat financed or leased?

Owned Financed Leased

Boater safety course completed?

Yes No

Current Carrier

Desired Effective Date *

Notes & Final Review

Almost done! Add your notes, review any flags, then submit.

Your Name *

Best Time to Reach Client

Preferred Contact Method

📋 Auto-Generated Intake Summary

Summary will appear here when you reach this step.

Auto-filled from your intake answers. Add any extra detail below.

Additional Notes / Special Circumstances

✅

Intake Submitted!

Intake for has been submitted.

Unable to Quote

Property Ownership Note

Start New Client Intake

Quick Qualification Check

🚗 Auto & Motorcycle Questions

🏠 Home & Renters Questions

Client Information

🏠 Home Insurance Details

🏢 Renters Insurance Details

🚗 Auto Insurance Details

🏍️ Motorcycle Insurance Details

❤️ Life Insurance Details

⛵ Boat Insurance Details

Notes & Final Review

Items Flagged During Intake

Intake Submitted!