[Breathe Memo Center] – Breathe Insurance

Breathe - Memo Center

Required Extension Fields

EZLynxAppID*
Email*
Select Memo Type
- New Business / Agent
- Renewal / Account Manager
Send From:*
Select Carrier:*
Information Required Memos

Memo - Information Required
Enter Data into Email:
Enter Current Odometer Reading (Only for 3rd Party ODO Memo)
**Enter the following info in the field above:
- Returned Mail. Enter: Street, City, State, Zip
- Student Graduated. Enter: Child's First Name
- Good Student Discount. Enter: Student's First Name
- Proof of Professional Discount. Enter: First Name
- Verify Commute Miles. Enter in the following format sample:
XXXX's current work address: Street, City, State, Zip
- Verify VIN #: Enter: Year, Make, Model, VIN #
- Auto NOT on Policy. Enter: Year, Make, Model
- Proof of Non-Fault Accident. Enter: "Driver Name on Date"
- Proof of GS - Not Received. Enter: First Name
- Proof of GS - Invalid: Enter: First Name
- Business Use Verification. Enter Name(s): John, John and Cindy
- Verify Specific Household Member: Enter Full Name: Deepak Chopra
- Proof of DL Reinstatement. Enter Full Name: Tony Robbins
- Excluded Driver - Enter: John Doe
NO Information Required Memos

For Auto:
For Property:
Payment Memos

For Payment Memos
Enter Data into Email:

Enter in Policy Number
Start Mercury Photo Request

PHOTO REQUIREMENT REMINDER
- START Photo Request
- STOP Photo Request
NOTE: Upon receipt of photos, you must come back to this form and STOP this campaign.
STOP Memo Center by Gravity Form

- Memo Completed
- STOP Memo Center
*
- ChromeToMemo