Submit Your Business

Please fill in the following information to submit your business into our pending business tracking sheet. If this policy is a split commission please make sure to submit two separate forms per agent and use the correct APV that reflects your commission %.

Date Submitted

Use the date that you submitted into Opt

Agent

First and Last Name

Agent Writing Number

If you're not contracted yet, please put pending

Manager/KeyLeader

Select Your Manager or Keyleader from the Drop Down List

Insured

Enter the Client's First and Last Name (Not the Lead Name) Ensure spelling is accurate to what Carrier has.

Carrier

Select Your Carrier / Insurance Company

Policy Type

APV

Take the Monthly Premium X 12 months and enter it in. DFL's cannot include PUA (Paid Up Additions) If this is a split app ensure both agents submit into airtable with the APV reflecting the split %.

EFT Set For

What date is the payment scheduled for?

Notes

Did you submit your application into Opt?

I understand that my application will not be sent to the carrier by submitting it on this tracking form and that I need to upload it into Opt! when I create the transmittal page. I also understand filling in the above information and clicking submit is a necessary step to complete the entire upload an application process in order for my applications to get to all the necessary insurance companies, departments, and for my numbers to be recorded, in order to receive my promotions.

Do not submit passwords through this form. Report malicious form

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