Current Quote Status
Started:
10/18/2017
Incomplete Provide Basic Information
Incomplete Add Classifications
Incomplete Answer Eligibility Questions
Incomplete Generate Applications
Incomplete Submit For Binding Approval
Quote Look-Up
Rachel Patterson, CIC

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If at any time you need assistance please contact Rachel Patterson, CIC at or rachel@jsausa.com

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Applicant Information
Applicant Name:
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Agency Information
Agent Name:
Note: This is the name of the agent requesting the quote, NOT the agency name.
Agency Name:
Agency Phone:  -  - 
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Underwriting Questions
What is the desired effective date?
How many losses has the applicant had within the last 3 years?
Does applicant perform any roofing work of any kind?  Yes
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