Patrick Battle, CIC, CPRIA

So, how may I help you?

Please select an option below

• Agent/Broker Change - Authorization Form Click here to complete this form. 2 minutes
• Automobile Insurance Card Request Form Complete this form to request an automobile insurance card be sent to you for your personal or commercial insurance policy. 1 minute
• Boating Resume of Experience Complete this form to provide boating experience information about a watercraft operator. 5 minutes
• Builders Risk Extension Questionnaire Complete this form for a Builders Risk Policy Extension request. 5 minutes
• California Location Check Form Complete this form to provide details about a location in California. 2 minutes
• Commercial Certificate of Insurance Request Form Click here to start the quoting process 3 minutes
• Commercial Insurance Coverage Declination Form Complete this form when rejection certain commercial insurance coverages. 2 minutes
• Commercial Property Profile (COPE) - Single Building Form Complete this form to provide construction, occupancy, protection and exposure (COPE) information about a single building. 3 minutes
• Confirmation of Completed Repairs Complete this form to provide confirmation of completed repairs after a claim. 2 minutes
• Contact Information Update Form Click here to provide updated contact information 2 minutes
• Customer Experience Feedback Form Click here to give us your feedback. 1 minute
• Data Deletion Test - Delete entry permanently Testing deleting data permanently after a certain number of days. 1 minute
• Data Deletion Test - erase certain data Testing personal data deletion 1 minute
• File Upload Form
• Flood Insurance Selection/Rejection Form Complete this form to select or reject flood insurance coverages.
• General Claim Report Form Complete this form to submit information about a new claim. 3 minutes
• Home Replacement Cost Appraisal Analysis Form Click here to compare proposed home valuations to appraised values. 5 minutes
• Legal Entity Information Form Click here to enter information about your legal entity 2 minutes
• Mortgage Closing Insurance Verification Request - Lender Form Click here to submit the mortgage information and other details 2 minutes
• Multi-Factor Authentication Attestation Complete this form to provide a signed multi-factor authentication attestation for your company. 3 minutes
• Nested Form Test Nested Form Test 11
• New Vehicle Information - Client Form - NEW Complete this form when purchasing a new vehicle. 3 minutes
• New Vehicle Information Client Form Please click here to complete this form 3 minutes
• New Vehicle Information Dealer Form Please enter the information requested below about the new vehicle. 3 Minutes
• New Vehicle/Automobile Information - Dealership/Seller Form Complete this form to provide information about a vehicle to your client's insurance agent. 3 minutes
• Older Structure Updates Form Complete this form to provide information about updates made to older structures. 2 minutes
• Personal Automobile Coverage Suspension Request Form Complete this form to request suspension of coverage on your personal automobile while it is not in use. 2 minutes
• Personal Automobile Glass Claim Request Form Complete this form to provide information about glass damage you would like to submit a claim for. 5 minutes
• Personal Automobile Insurance Claim Report Form Complete this form to notify the agency about a new personal automobile insurance claim. 5 minutes
• Personal Cyber Insurance Coverage Request - PURE Insurance Company Complete this form to add cyber insurance protection to your insurance portfolio. 2 minutes
• Personal Excess Liability / Umbrella - Coverage Increase Request Complete this form to request a higher excess liability limit. 1 minute
• Personal Insurance Cancellation Request Complete this form when canceling a personal insurance policy. 2 minutes
• Personal Insurance Claim Feedback Form Complete this form to provide feedback about a claims experience for a personal insurance policy. 3 minutes
• Personal Insurance Coverage Declination Form Complete this form when rejection certain personal insurance coverages. 2 minutes
• Personal Insurance Policy Changes for Multiple Policies Form Complete this form to request a policy change for your homeowners, valuables articles and/or automobile policies. 5 minutes
• Personal Insurance Proposal - Carrier Comparison Form Complete this form to create a personal lines proposal that compares two carriers. Varies
• Personal Insurance Proposal - Single Carrier Form Complete this form to create a single carrier personal insurance proposal. Varies
• Personal Insurance Proposal HNW Complete this form to enter data that will populate the personal lines proposal. 4 minutes
• Personal Insurance Renewal Checklist Click here to begin the renewal review process 3 minutes
• Personal Insurance Side by Side Proposal Database Complete this form to populate the side by side proposal with values. 10 minutes
• PRMA Chapter Feedback Form Complete this form to provide feedback. 2 minutes
• PRMA NY Metro Chapter Gingerbread House Exhibition Registration Form Complete this form to enter the PRMA NY Metro Chapter Exhibition
• Producer Issuance - Personal Lines Form Click here to complete this form. 5 minutes
• Producer Quote Options Form - Personal Lines Click here to complete this form 5 minutes
• Rental Car Request Form - Go Rentals Complete this form to request a rental car while your car is being repaired. 1 minute
• Residence Rented to Others Form Complete this form to provide details about a residence that is rented to others.
• Residential Fire Protection Evaluation - Department Form Complete this form to provide fire protection information for a residential property. 5 minutes
• Side by Side Proposal Tester Side by Side Proposal Tester Varies
• Solar Panel Information Form Complete the form to provide information about a solar panel system. 3 minutes
• Statement of Diligent Effort - Florida Form Complete this form to create a statement of diligent effort form for Florida excess and surplus lines placements.
• Statement Of No Loss Use this form to obtain a signed statement of no loss. 2 minutes
• Vacation Rental Home Supplemental Form Complete this form to provide additional details about a vacation rental property. 5 minutes
• Watercraft Severe Storm Statement Form Complete this form to verify precautionary plans for a watercraft in the event of a severe storm. 5 minutes
• Wondeur.ai Artist Report Request Form Complete this form to request a Wondeur.ai artist report. 1 minute