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Lead Information Example
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CityInsuranceAgents.com - 3324 W. University Ave. # 285 - Gainesville, Florida 32607
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Applicant_First_Name: Bob
Applicant_Middle_Initial: W
Applicant_Last_Name: Smith
Address_to_be_Insured: 555 NW 45th Street
City: Miami
Zip_Code: 33125
Applicant_Mailing_Address: 555 NW 45th Street
City: Miami
Zip_Code: 33125
Applicant_Email_Address: bobs@yahoo55.com
Applicant_Home_Phone: 305-555-5555
Applicant_Work_Phone: 305-555-4444
Extension_Number: 55
Contact_Me: Phone at Home
Applicant_Cell_Phone: 305-555-7777
Birth_Date: 5/21/1965
Social_Security_#: 455-80-4595
Spouse_First_Name: Mary
Spouse_Middle_Initial: A
Spouse_Last_Name: Smith
Spouse_Birth_Date: 6/9/1972
Spouse_Social_Security_#: 631-12-5555
Flood_insurance_policy_in_force: no
Currently_Insured?: Yes
Coverage_Requested_For: Primary Residence
Usage_Type: Primary Residence
Years_Lived_at_Address_to_be_Insured: Over 5 years
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Building_Structure: Brick Veneer
Year_Dwelling_Built: 1985
Dwelling_Square_Feet: 2,685
Smoke_Detectors?: Yes
Deadbolt_Locks?: Yes
Central_Burglar_Alarm?: No
Central_Fire_Alarm?: No
Sprinklered_All_Rooms?: No
Primary_Heat_Type: Central
Fireplace: Yes
Full_Baths: 2
Half_Baths: 1
Garage: attached
Garage_Size: 2 car
Basement: No
Type_of_Wiring: Circuit Breakers
Wiring_Renovation: None
Plumbing_Renovation: Partial
Plumbing_Renovation_Year: 2004
Heating_Renovation: None
Roofing_Renovation: Complete
Roofing_Renovation_Year: 2005
Roof_Type: Composition
Roof_Age_(years): 4
Exterior_Paint_Renovation: Partial
Exterior_Paint_Renovation_Year: 2002
Dwelling_Distance_from_Fire_Department: 5 miles
Dwelling_Occupied_By: Owner
Swimming_Pool: None
Diving_Board: No
Pool_Screened: No
Approved_Fence: Yes
Any_losses_last_5_years?: Yes
Loss_Date1: 7/25/2004
Loss_Type1: hurricane
Loss_Description1: roof tiles torn off
Loss_Amount1: $12,000
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Contact Information
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Property Information
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Dwelling_$_Value: 400,000
Additional_Structures_$_Value: none
Personal_Property_$_Value: 100,000
Personal_Liability_(each_occurence): $100,000
Medical_Payments_(each_person): $5,000
Other_Perils_Deductible: $2,500
Windstorm_Deductible: 2%
Replacement_Cost,_Dwelling: Yes
Replacement_Cost,_Contents: Yes
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