NEW ALLSTATE PERSONAL LEAD
Make sure you CHECK by phone # on BLITZ it is NOT A DUPLICATE!
Please Double Check the information is correct!
Name
:
*
Required
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Contact Name
:
*
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Idioma
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ENGLISH
SPANISH
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Address 1
:
*
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City
:
*
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State
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*
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland and Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
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Zip Code
:
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Phone
:
*
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Email Address
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*
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Description
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*
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First Name:
:
*
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Last Name:
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*
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Date of Birth:
:
*
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Gender
:
*
Female
Male
Required
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Marital Status
:
*
Divorced
Married
Single
Widowed
Required
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Spouse Name-Date of Birth Age:
:
Required
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Ownership Type:
:
*
Owns
Rents
Wants Homeowners Quote
Required
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1 Year / Make / Model
:
*
Required
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2 Year / Make / Model
:
Required
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3 Year / Make / Model
:
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Driver 1 Name-Age:
:
Required
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Driver 2 name-Age:
:
Required
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Address Verified? NO=A-
:
*
NO
SI
Required
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A+ Cuando renueva su poliza actual?
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*
January 2025
January 2025
S
M
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W
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F
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53
29
30
31
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2
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2
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3
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4
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25
5
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27
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29
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31
1
6
2
3
4
5
6
7
8
Required
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A+ Current Insurance Company:
:
*
Allstate
Bristol West
Farmers
Geico
Infinity / Kemper
Liberty Mutual
Mercury
Metlife
National General
No insurance
Other
Progressive
State Farm
Travelers
United
Usaa
Required
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Source:
:
*
Base Datos Elias
Base Datos Emy
Contractor list
E-mail leads
Home Advisor
houzz
Manta
Old follow up
Sales Genie
Yellow pages
Required
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Skyline Agent
:
*
Required
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Calidad
:
A
A -
A+
Required
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Submit
CALIDAD A- Es un Lead Incompleto (OPPORTUNITY) A Es un Lead Completo pero con dudoso interes o sin urgencia (urgencia de comprar rapido) A+ Es un Lead Completo y interesado y/o con urgencia de comprar pronto