Quote Request – Purely Insurance

EZLynxAppID*
Email*
Your Name*
Customer Name (First and Last Name)*
Select Quote Request Type*
Critical Same Day Quote Request Cut Off Times:
• Remarket Monoline Policies – 4 p.m.
• Remarket Package Policies – 3 p.m.
• New Business Monoline Policies – 3 p.m.
• New Business Package Policies – 24 HR Completion Time
Enter Date of Quote Request*
MM slash DD slash YYYY
Current Expiration Date:
MM slash DD slash YYYY
Critical Due Date
MM slash DD slash YYYY
You must enter in their current policy expiration date. If this is a midterm remarket, put the date that you need quotes to return in your notes below.
Marketing Preference:
If this is a New Business Quote, please provide:
• Deducticble
• Limit of Liability
• Perferred Dollar Per Sq. Ft.
• And so on…
Notes To Quoting*
Note: Be sure to indicate where Quote Data is located. For example: Current Client - no new info, EZLynx Documents, Infusionsoft File Box.
Companies to Quote:*
Respond to RC LOW RISK Negative Response from Client

Do you have documents to upload for Quoting?*
Upload Documents that will be helpful to the PH Team.

Drop files here or

Max. file size: 128 MB.

Required Extension Fields