Coverage Targets & Current Policy — Update / setup form (auth-only) for Insurance. Embeddable version — a transparent, chrome-free form that floats over your own website design (pair with the standalone version for a hosted page).

The coverage you want and how your current policy is set up, so we can quote it accurately.

What it collects (by section):

• Coverage targets — Primary Liability Limit Target [dropdown: $300k / $500k / $1M / $2M / $5M / …]; Umbrella/Excess Limit Target [dropdown: None / $1M / $2M / $5M / $10M / …]; Primary Deductible Preference [dropdown: $500 / $1k / $2.5k / $5k / $10k / …]; Coverage Enhancements Sought [multi-select: Replacement cost / Business income/extra expense / Hired & Non-Owned Auto / Cyber add-on / Flood / …].
• Your current policy — Current Policy Number(s) (optional) [short text]; Current Premium (annual est.) [number]; Prior Coverage Lapse (36 mo.) [dropdown: No / Yes - <30 days / Yes - <30 days / Unknown]; Remarketing Permission (renewal) [choice: Yes / No / Case-by-case]. Where things stand today — references only, never account numbers.
• Billing & payment — Billing Plan Preference [dropdown: Paid in full / Semi-annual / Quarterly / Monthly / Agency bill / …]; Payment Method Preference (insurance) [dropdown: ACH / Credit/Debit card / Check / Employer deduction / Other].
• Certificates & additional insureds — Certificates of Insurance Needed [choice: Yes / No / Possibly later]; COI Holder List (names/emails) [long text]; Additional Insureds Required [choice: Yes / No / Unsure]; Additional Insured Names [long text]; Waiver of Subrogation Needed [dropdown: No / Yes - blanket / Yes - specific parties / Unsure].

Form type: Update / setup (up), auth-only. Niche: Insurance. Deployment: embed.

Best for / surface when: Insurance client workflow — coverage targets & current policy.