Bint It! | Inspirion Insurance Solutions

How many policies are you binding?
Bind Notes:
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Policy 1
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy?
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Policy 2
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy?
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Policy 3
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy?
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Policy 4
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Policy 5
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy?
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Policy 6
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy?
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Policy 7
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy?
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Policy 8
Policy Type
Property Type
Effective Date
MM slash DD slash YYYY
Mortgagee Billed
Vesting Name
Vesting Address
Street Address Address Line 2 City State ZIP Code
Loan #
Mode of Payment
Pay Plan
Authorized First Payment Amount
Vehicle Type
Effective Date
MM slash DD slash YYYY
Primary Insured Occupation
Primary Insured Address
Street Address Address Line 2 City State ZIP Code
Spouse / Partner Occupation
Spouse / Partner Address
Street Address Address Line 2 City State ZIP Code
How Many Autos on Policy?
Auto 1: Model
Auto 1: Odometer
Auto 2: Model
Auto 2: Odometer
Auto 3: Model
Auto 3: Odometer
Auto 4: Model
Auto 4: Odometer
Auto 5: Model
Auto 5: Odometer
Auto 6: Model
Auto 6: Odometer
Mode of Payment
Pay Plan
Authorized First Payment Amount
Other Type
Mode of Payment
Pay Plan
Authorized First Payment Amount
Payment Information
Payment Method
Account Number
Routing Number
Draft Date
MM slash DD slash YYYY
Credit Card Number
Expiration Date
MM slash DD slash YYYY
3-digit Security Code
Billing Zip Code
Instructions
Do you need to send an Accord Loss Policy Release?
For which policy?
Applications:
Send to Client After Binding
- ID Cards
- Receipts
- ID Cards and Receipts
- Proof of Insurance (All Policies)
- Nothing
Notes

Bind It!

Policy 1

Policy 2

Policy 3

Policy 4

Policy 5

Policy 6

Policy 7

Policy 8

Payment Information

Instructions