New Personal Client Onboarding

Personal Client Onboarding Form

At Eastman Insurance Solutions, we start by learning the basics about your household and the personal assets you want to protect. Our Personal Client Onboarding Form gathers the key details we need to create your file, connect you with the right advisor, and begin reviewing your insurance needs.

This short form asks for essential information such as household members, property and vehicle details, drivers, current insurance providers, and your coverage preferences. You do not need to upload documents at this stage. Once your profile is set up, your EIS advisor will review your existing policies, identify any gaps, and help design a protection plan that fits your needs.

This process is ideal for commercial clients who want both business and personal coverage managed under one advisory relationship, as well as individuals looking for a higher level of service. If you want clear guidance and dependable personal insurance support, you’re in the right place.

This process will take you approximately 10 minutes to complete. To alleviate redundant back and forth, please complete in its entirety.

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Step 1 of 4 - General Information

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General Information

First Named Insured*

First Last

Second Named Insured (If Applicable )

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Current Insurance Provider*

What Brought You To Eastman Insurance Solutions?*

Are you seeking Auto, Home or Both*

I am an Existing Client, I need a new Home Policy

I am an Existing Client, I need a new Auto Policy

I am a New Client, I need Both, Home and Auto

Home Information

This Property Is......

Physical Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Property Characteristics

Please be as accurate as possible

Year Built*

Square Footage*

List of Updates Of Home Since Original Construction.*

Example: Kitchen Remodel, 2009

Flooring Material?*

Complete to 100% (e.g. Laminate 60%, Tile 20%, Carpet 20%)

Roofing Material*

Solar Panels? If Yes, How Many?*

Fire and Theft Protection Information

Name Of Fire Department*

Fire Hydrant Within 1000 Feet Of Home?*

Yes, Within 1000 Feet

No, Over 1000 Feet

No Hydrant Present

Distance to Responding Fire Station*

Fire Extinguisher Present*

Smoke Detector*

co2 Detector*

Interior Sprinklers?*

Monitored Burglar / Fire Alarm?*

Coverage & Loss History

Current Liability Limits

Med Pay Limit

Desired Deductible

Any Home Claims Filed In The Last 5 Years?*

Yes

Number Of Claims Over 1000 Paid Out?

In the last 5 years

Current Insurance Carrier?*

Current Policy Expiration Date*

MM slash DD slash YYYY

Auto Insurance Section

How Many Drivers?*

Driver #1

Driver Name

Date Of Birth

Month

Day

Year

Age Licensed?

Marital Status

Gender

Occupation

Minor Violations - Last 3 Years

Minor violations include Speeding, Failure to Stop, Failure to Yield, Seatbelt violations etc.

Major Violations - Last 10 Years

Major violations include DUI, Reckless Driving, Speeding Over 100, etc.

Accidents - Last 5 Years

Include ALL accidents regardless of fault.

Driver #2

Driver Name

Date Of Birth

Month

Day

Year

Age Licensed?

Marital Status

Gender

Occupation

Minor Violations - Last 3 Years

Minor violations include Speeding, Failure to Stop, Failure to Yield, Seatbelt violations etc.

Major Violations - Last 10 Years

Major violations include DUI, Reckless Driving, Speeding Over 100, etc.

Accidents - Last 5 Years

Include ALL accidents regardless of fault.

Driver #3

Driver Name

Date Of Birth

Month

Day

Year

Age Licensed?

Occupation

Marital Status

Gender

Minor Violations - Last 3 Years

Minor violations include Speeding, Failure to Stop, Failure to Yield, Seatbelt violations etc.

Major Violations - Last 10 Years

Major violations include DUI, Reckless Driving, Speeding Over 100, etc.

Accidents - Last 5 Years

Include ALL accidents regardless of fault.

Driver #4

Driver Name

Date Of Birth

Month

Day

Year

Age Licensed?

Marital Status

Gender

Occupation

Minor Violations - Last 3 Years

Minor violations include Speeding, Failure to Stop, Failure to Yield, Seatbelt violations etc.

Major Violations - Last 10 Years

Major violations include DUI, Reckless Driving, Speeding Over 100, etc.

Accidents - Last 5 Years

Include ALL accidents regardless of fault.

How Many Vehicles?*

Vehicle #1

Year, Make, Model, Trim

Example: 2015 Lexus 570 Base

VIN (If Available)

This Allows Us To Provide The Most Accurate Rates

Primary Driver Name

Please assign a primary driver from the previous page. NOTE: Any listed driver has coverage on all vehicles.

Annual Miles Driven

Annual miles are an important rating factor, please be as accurate as possible.

Comprehensive Deductible

Your out of pocket expense for damage to your vehicle other than Collision

Collision Deductible

Your out of pocket expense for damage to your vehicle from a Collision

Is This Vehicle Financed?

Yes

Leased

Vehicle #2

Year, Make, Model, Trim

Example: 2015 Lexus 570 Base

VIN (If Available)

This Allows Us To Provide The Most Accurate Rates

Primary Driver Name

Please assign a primary driver from the previous page. NOTE: Any listed driver has coverage on all vehicles.

Annual Miles Driven

Annual miles are an important rating factor, please be as accurate as possible.

Comprehensive Deductible

Your out of pocket expense for damage to your vehicle other than Collision

Collision Deductible

Your out of pocket expense for damage to your vehicle from a Collision

Is This Vehicle Financed?

Yes

Leased

Vehicle #3

Year, Make, Model, Trim

Example: 2015 Lexus 570 Base

VIN (If Available)

This Allows Us To Provide The Most Accurate Rates

Primary Driver Name

Please assign a primary driver from the previous page. NOTE: Any listed driver has coverage on all vehicles.

Annual Miles Driven

Annual miles are an important rating factor, please be as accurate as possible.

Comprehensive Deductible

Your out of pocket expense for damage to your vehicle other than Collision

Collision Deductible

Your out of pocket expense for damage to your vehicle from a Collision

Is This Vehicle Financed?

Yes

Leased

Vehicle #4

Year, Make, Model, Trim

Example: 2015 Lexus 570 Base

VIN (If Available)

This Allows Us To Provide The Most Accurate Rates

Primary Driver Name

Please assign a primary driver from the previous page. NOTE: Any listed driver has coverage on all vehicles.

Annual Miles Driven

Annual miles are an important rating factor, please be as accurate as possible.

Comprehensive Deductible

Your out of pocket expense for damage to your vehicle other than Collision

Collision Deductible

Your out of pocket expense for damage to your vehicle from a Collision

Is This Vehicle Financed?

Yes

Leased

Vehicle #5

Year, Make, Model, Trim

Example: 2015 Lexus 570 Base

VIN (If Available)

This Allows Us To Provide The Most Accurate Rates

Primary Driver Name

Please assign a primary driver from the previous page. NOTE: Any listed driver has coverage on all vehicles.

Annual Miles Driven

Annual miles are an important rating factor, please be as accurate as possible.

Comprehensive Deductible

Your out of pocket expense for damage to your vehicle other than Collision

Collision Deductible

Your out of pocket expense for damage to your vehicle from a Collision

Is This Vehicle Financed?

Yes

Leased

Vehicle #6

Year, Make, Model, Trim

Example: 2015 Lexus 570 Base

VIN (If Available)

This Allows Us To Provide The Most Accurate Rates

Primary Driver Name

Please assign a primary driver from the previous page. NOTE: Any listed driver has coverage on all vehicles.

Annual Miles Driven

Annual miles are an important rating factor, please be as accurate as possible.

Comprehensive Deductible

Your out of pocket expense for damage to your vehicle other than Collision

Collision Deductible

Your out of pocket expense for damage to your vehicle from a Collision

Is This Vehicle Financed?

Yes

Leased

Auto Coverages

Liability Limits Requested*

Average - $100,000/$300,000

Preferred - $250,000/$500,000

Ultra Preferred - $500,000/$500,000

Liability provides coverage for those you injure in an accident, outside of your vehicle.

Property Damage*

Property damage covers the damage you cause to someone else's property in an accident

Medical Payments*

Med-Pay Covers out of pocket medical expenses for injuries sustained by you or other individuals in your car in an accident that is your fault.

Optional Coverages

Rental Reimbursement

Roadside Assistance

OEM Replacement Parts

Full Glass Coverage

Special Equipment

Finalizing

Can we assist you with any other policies?

Umbrella Insurance

Rental Properties/Landlord Insurance

Motorcycle Insurance

Classic/Collector/Exotic Car Insurance

CCW - Firearm Liability/Self Defense Insurance

Business Liability Insurance

Business Property Insurance

Workers Compensation Insurance

Commercial Auto Insurance

Bonds

EIS is a full service insurance agency, with access to over 100 insurance carriers, we can match your insurance needs with the right carrier to assure you are getting the best value for your insurance premium.

Secured Document Upload

Drop files here or

Max. file size: 98 MB, Max. files: 10.

If you have copies of your current insurance coverage, it is extremely helpful if you provide your current insurance docs, this allows us to provide a more comprehensive review.