BrokerageBuilder Partner Discovery Questionnaire

Hi , please fill out the form below so we can get started on your BrokerageBuilder setup.

Accounts

How are your accounts managed right now?*

Agency Management System
Spreadsheets
Paper Records and Files
Other

Please Explain...*

What Type of AMS do you use?*

Is there a date the agency will lose access to its AMS?*

No
Yes

What is that date?*

Are producers using the system(s) mentioned above for both clients and prospects?*

Yes
No

Are you planning to include group leads and accounts for your initial upload?*

Yes
No

Total number of group leads vs accounts*

Are you planning to include individual leads and accounts for your initial upload?*

Yes
No

Total number of individual leads vs accounts*

Is there a need to load in any quoted plans?*

Yes
No

Are there any additional account fields you feel would need to be created as custom in your system?*

BrokerageBuilder has a list of default fields at the Account level. Hover the icon to see all default fields.

Yes
No

List additional account fields here

Please add the fields you will need for tracking and reporting purposes.

Common additions are: Tax ID, Notes/Comments, Business Type, Payroll Frequency

Plans

Please choose the plan types you are currently using that are attached to your plan data*

List additional plan types here

Please choose from the Beginning Policy Status options you would like set up*

NEW – brand new business never held before
REN – renewed policy using the same carrier as previous term
REW – renewed policy using a different carrier from previous term
BOR or AOR

Beginning policy status is required for all plans and based on a plan’s effective date, helps track how the plan originated.

Does your agency use AOR or BOR?*

BOR – Broker of Record
AOR – Agent of Record

Please add any additional statuses not listed

Are there any additional plan fields you feel would need to be created as custom in your system?*

BrokerageBuilder has a list of default fields at the Plan level. Hover the icon to see all default fields.

Yes
No

List aditional plan fields here

Please add the fields you will need for tracking and reporting purposes.

Common additions are: Grandfathered Plan?, Rate Guarantee Date

Comissions

Will your agency be using the commission tracking module within BrokerageBuilder?*

Yes
No

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Users

Please list all active users who will have access to BrokerageBuilder

First Name	Last Name	Email Address

Do you have a large amount of users needing to be added?

You can send an excel spreadsheet to us instead.

Accepted file types: xlsx, Max. file size: 24 MB.

Please list any outside producers or users tied to commission tracking who will not access BrokerageBuilder

First Name	Last Name	Email Address

Do you have a large amount of outside producers or users tied to commission tracking needing to be added?

You can send an excel spreadsheet to us instead.

Accepted file types: xlsx, Max. file size: 24 MB.

Please choose from the agency user roles you would like setup at the account level*

Account Executive
Account Manager
Customer Service Representative
Principal
Producer

Please add any additional user roles not listed

Questions about any area(s) in this form?

Contact your Implementation Consultant, at