Internal REI Discovery Form

Is this for a current insured or a prospect?*
- Current Insured
- Prospect
Effective Date for new insurance?
Date Format: MM slash DD slash YYYY
Investor Name
First Last
Entity or LLC Name
Investor Phone
Investor Email
Investor Date Of Birth
Date Format: MM slash DD slash YYYY
Investor Mailing Address
Street Address Address Line 2 City State ZIP Code
Is the Contact Name different from the Investor Name?*
- Investor and Contact are the same
- Investor and Contact are different
Contact Name
First Last
Additional Phone
Additional Email
Property Address to be quoted
Street Address Address Line 2 City State ZIP Code
Property Type*
Annual Lost Rents Coverage
Number of Units
Policy Term Needed
Coverage Amount ($):
How will this policy be paid for?
List any applicable mortgagee or lienholder
Include mortgagee clause and mailing address
List any applicable Additional Insured party
include mortgagee and mailing address
Is the property we're quoting a new build?
- No
- Yes
How did they first hear about RiskWell?
What else do we need to know? (Other lines of business, expectations, land mines, etc.)
Attach any relevant documents
Insured will receive an automated email request for documents as well.
Drop files here or

First Name	Last Name	Date Of Birth	Driver's License #

Year	Make	Model	Vehicle ID # (VIN)