Sign Up – Agent

This form should be filled out only by approved managers/owners

Please provide minimum of 3 business days
New licenses assigned to this user will be billed at the beginning of the next month. Epic licenses will additionally be prorated from the date the license is activated.
Your Information
Your Name (person filling out form)
First Last
Your Email (person filling out form)
New User Information
Franchise Name*
Start Date*
DD slash MM slash YYYY
Name of New Agent*
First Last
Preferred Name
This name will be displayed in Microsoft account
Gender*
Job Title / Position*
Manager/Supervisor*
Who will this person report to?
Joining us from another company?*
Contact Information
Please note that the contact methods provided here may be visible to others.
Office Phone
Mobile
Fax
Personal Email*
Current Email Confirm Email

Personal email contact for the user may be used to provide credentials or to confirm user's identity.
Requested InsureLine email address*

Please keep email address formats consistent within your business. firstname.lastname@insureline.com is strongly encouraged.
Requested email aliases

Alias addresses will deliver emails to the same mailbox, but cannot be used to log into systems.
Insurance Servicing Information
Insurance License Type*
Year started in the insurance industry*
Broker Management System most familliar with
Professional Designation(s)
Servicing Role(s)
- CSR
- Producer
Total Policy Volume ($) from the past 12 months
Will this user be a commisionable producer?*
- No
- % of Agency Commision
- Flat $ Amount
Agency Commission (%)
- New
- Renewal
- Other
If selecting other please give details in the additional information section below
Agency commission % on NEW BUSINESS*
Please enter a number less than or equal to 100.
Agency commission % on RENEWALS*
Please enter a number less than or equal to 100.
Flat Commission Amount ($)*
Any additional information required regarding this commission agreement
Which Epic branch(es) will this user be associated with for the purposes of billing?
This determines where the user will appear as an option in drop-down boxes etc.
Epic
Epic licenses are billed monthly at $360/month.

New Licenses will incur a $500 administration fee and billing will be prorated from the date the license is activated.
Will the user require an Applied Epic license?*
- Yes
- No
By selecting Yes you approve the purchase of a new license if none are currently available for your franchise
List users who should have access this new user's Tasks and Activities
The people listed will be able to see Tasks and Activities owned by the newly created user.
Which user's Tasks and Activities should this new user have access to?
The people listed will have their Tasks and Activities shared with the newly created user.
Is a separate branch required in Epic?*
- Yes
- No
A separate branch may be used to isolate a producer's book but will require additional management.
List any additional users who will require access to this new branch
Please list specific users
List all Epic branches this new user will need access to
User will be able to access client and policy information within these branches
Should the user be added to any SALES TEAMS?
Should the user be added to any WORKGROUPS?
Are any additional Epic permissions required?
Bank accounts, specific security groups, etc
Should the user be assigned dashboard roles?
- Account Manager/Servicing Rep
- Accountant
- Department Manager
- Producer
- Sales Manager
PandaDoc
PandaDoc is billed at $12.50/month. Billing will begin at the start of the upcoming month.
Do you require an Electronic Signature (PandaDoc) license?*
- Yes
- No
Ubity Phones
Ubity extensions are billed at $20.50/month. New DIDs are billed at $3.08/month. Billing will begin at the start of the upcoming month.
Will this user require a Ubity extension?*
- No
- Yes - New Extension
- Yes - Reassign Extension
Request specific extension
Whose extension should be reassigned to this user?*
Will this user require a DID (external phone number)?*
- No
- Yes - New DID
- Yes - Reassign DID
DID to reassign*
Should the user be added to any call groups/queues?*
Any additional information needed to complete Ubity set up
Microsoft 365 Apps
All users will have access to Email, Teams, OneDrive and the Microsoft Office 365 web suite.
Desktop apps are required to install Word, Excel, Powerpoint and Outlook.
Does the user require desktop office apps?*
Will the user be working from an InsureLine owned and managed device?*
Managed Services
Managed Services is required, as per our cyber insurance, for access to InsureLine resources.
Each active user in your business will be billed at a rate of $10/month.
Each device in your business will be billed at a rate of $10/month.

These charge cover the cost of additional security software, as well as the increased access to support.

Examples:
A user who works from a single device will be billed at $10+$10 = $20/month.
A user with a laptop at home and a desktop in the office will be billed $10 + $10 + $10 = $30/month.
Please speak with your manager for more information on how these costs will be distributed in your business.
What device(s) will this user be working from?*
Please provide the name(s) of the device(s) the user will be working from
Additional Notes
Additional information, notes or questions relevant to this onboarding

Sign Up – Agent

This form should be filled out only by approved managers/owners

Your Information

New User Information

Contact Information

Insurance Servicing Information

Epic

PandaDoc

Ubity Phones

Microsoft 365 Apps

Managed Services

Additional Notes