New Vehicle Purchase

Error: Contact form not found.

Umbrella Risk Calculator

Home & Auto Renewal Survey

    Your name

    Street address

    Your preferred email

    Best phone number to reach you

    Please indicate your current marital status.
    singlemarriedengageddivorcedwidowed

    Spouse's first and last name

    Best phone number for spouse.

    Email address for spouse.

    Home Questions

    Since your last review...

    Has anyone moved in or out of the household in the last 12 months?
    *students away at college are still considered household members
    yesno

    If so, please explain

    Have you installed a (third-party) monitored security or fire alarm system in the past 12 months?
    yesno

    Do you, or another household member, work from home?
    yesno

    Are there any business operations conducted in the home?
    daycare, music lessons, hairstylist, etc..

    Please provide more detail

    What is the estimated value of your personal property at your residence that you use for work?
    ex: computer, laptop, desk, furniture, filing cabinets, etc

    Have you made any significant home improvements?*
    *wiring, HVAC, plumbing, roof, additions, etc...
    yesno

    Please provide more details:

    Have you purchased any other properties?
    *rentals, secondary or seasonal home
    nonerentalsecondary/seasonal

    Have you purchased any of the following or similar items?
    nonewatercraftmotorcyclesnowmobileRVATV

    Have you acquired any pets or livestock?
    yesno

    Please provide more detail (type, breed, count) :

    Have you installed any of the following or similar items?
    nonepooljacuzzitrampolinefree standing wood stove

    Have you acquired any valuable collections?
    *artwork, jewelry, furs, precious metals or guns, etc...
    yesno

    Please provide more details:

    Are you satisfied with your current deductible?
    yesnocontact me with options

    Your insurance company has additional coverage options for home you might be interested in.
    (select your company below and choose the coverage(s) you would like more info about)

    sewer or drain backupextended water (flood)earthquakemine subsidence/sinkholewatercraft liabilityfarm equipmentfarm liabilityfarm livestockfarm propertyfarm operationsburied utility lineequipment breakdownidentity recovery/fraudnot interested

    sewer or drain backupearthquakeAAA membershipnot interested

    sewer or drain backupearthquakesinkholeequipment breakdownassisted living carehome cyber protectionburied utility lineidentity theftfarming liabilitynot interested

    sewer or drain backupearthquakeequipment breakdownidentity fraud expensedecreasing deductibleloss forgivenesspersonal injuryroof & siding matchingfarming liabilitywater seepage/leakageburied utility lineassisted living carenot interested

    sewer or drain backupearthquakemine subsidencegolf cart coveragehome computer coverageidentity managementnot interested

    sewer or drain backupearthquakehome day carefarming liabilityroof & siding matchingburied utility lineidentity theft recoverypersonal offenseequipment breakdownhome warrantypet health insurancenot interested

    sewer or drain backupearthquakeidentity recoveryhome systems protectioncyber/data breach/bullypersonal injurynot interested

    sewer or drain backupearthquakeequipment breakdownfarming liabilityburied utility linehome daycareassisted living carenot interested

    sewer or drain backupearthquakeequipment breakdownburied utility linehome-sharingsupplemental boat hull coveragecyber/identity theftnot interested

    Do you currently have a mortgage on your home?
    yesno

    We need to make sure we have the correct mortgage company listed on your policy. Please provide bank's name.

    Auto Questions

    Since your last review...

    Are there any newly-licensed drivers or any drivers no longer in household?
    yesno

    Please provide more details:

    Has a student moved away to college (100+ road miles) without the use of a vehicle?
    yesno

    Have you, or any driver, changed job or school locations or work from home?
    yesno

    Please explain:

    Does any household driver participate in any ridesharing activities? (Uber/Lyft driver, Door Dash, UberEats,etc)

    Please let us know which vehicle(s) are used

    Have any insured vehicles been customized or altered?
    yesno

    Please provide more details:

    Have you paid off any vehicle loans this past year?
    yesno

    Which loan(s) are paid off?

    What is the total number of vehicles registered to you and/or your spouse/significant other?
    (REMEMBER- you should not insure vehicles not registered to you/mate.)

    Have you considered increasing your liability limits for better protection of your assets?
    yes, more info pleaseno thanks

    Your insurance company has additional coverage options for auto you might be interested in.
    (select your company below and choose the coverage(s) you would like more info about)

    comprehensivefull glass $0 deductiblecollisionroadside serviceloss of use (rental car)new auto securityrideshare gap (Uber/Lyft)rate lockauto plus (dim. deductibles)not interested

    comprehensivefull glass $0 deductiblecollisionroadside assistanceloss of use (rental car)special equipmentloan/lease gap coveragenot interested

    comprehensivefull glass $0 deductiblecollisionroadsideloss of use (rental car)ID theftpet injurymobile devicesnew auto replacedeductible waiverloan/lease gapcustom equipmentrideshare gapminor violation forgiveaccident forgivenessnot interested

    comprehensive$50 glass deductiblecollisionroadsideloss of use (rental)loan/lease gapincreased custom equiplimited mexico coverageRDP accident/viol forgivePRDP (+dim deducts)new car replacementIntelliDrive savingsnot interested

    comprehensivefull glass $0 deductiblecollisionroadsideloss of use (rental)loan payoffincreased custom equipSnapShot savingsdiminishing deductiblespaperless discountnot interested

    comprehensivefull glass $0 deductiblecollisionroadsideloss of use (rental)accident forgivenessworld-wide rentalloan lease/gapnew vehicle replacementcustom equipemergency assistancerideshare (Uber/Lyft)claims free cash backnot interested

    full glass $0 deductiblenot interested

    full glass $0 deductibleenhanced collisionroadsidetrip interruptionloan/lease gapaccident forgivenesspet injurynot interested

    With regards to life insurance, select all that apply to you.

    How would you rate our service to you?
    below averageaverageabove averagesuperior

    Are there any areas you feel we could improve upon in providing service to you?
    noyes

    We welcome your feedback...

    Share this link with a friend to be automatically entered into our referral program where you can win gift cards and CASH! The more you refer, the more likely you'll win!
    https://wi-insure.com/referrals/

    Please consider leaving us a review here: (link opens new window)
    Leave us a review

    Homeowner's Renewal Survey

    Error: Contact form not found.

    Auto Renewal Survey

      Your name

      Street address

      Your preferred email

      Best phone number to reach you

      Please indicate your current marital status.

      Spouse's first and last name

      Best phone number for spouse.

      Email address for spouse.

      Auto Questions

      Since your last review...

      Are there any newly-licensed drivers or any drivers no longer in household?
      yesno

      Has a student moved away to college (100+ road miles) without the use of a vehicle?
      yesno

      Have you, or any driver, changed job or school locations or work from home?
      yesno

      Please provide more details:

      Does any household driver participate in any ridesharing activities? (Uber/Lyft driver, Door Dash, UberEats,etc)

      Please let us know which vehicle(s) are used

      Have any insured vehicles been customized or altered?
      yesno

      Please provide more details:

      Have you paid off any vehicle loans this past year?
      yesno

      Which loan(s) are paid off?

      What is the total number of vehicles registered to you and/or your spouse/significant other? (REMEMBER- you should not insure vehicles not registered to you/mate.)

      Would you be interested in bundling your homeowner's or renter's insurance with your auto?  multi-policy discounts can save you up to 40%!
      yesI already dono

      Have you considered increasing your liability limits for better protection of your assets?
      yes, more info pleaseno thanks

      Your insurance company has additional coverage options for auto you might be interested in.
      (select your company below and choose the coverage(s) you would like more info about)

      comprehensivefull glass $0 deductiblecollisionroadside serviceloss of use (rental car)new auto securityrideshare gap (Uber/Lyft)rate lockauto plus (dim. deductibles)not interested

      comprehensivefull glass $0 deductiblecollisionroadside assistanceloss of use (rental car)special equipmentloan/lease gap coveragenot interested

      comprehensivefull glass $0 deductiblecollisionroadsideloss of use (rental car)ID theftpet injurymobile devicesnew auto replacedeductible waiverloan/lease gapcustom equipmentrideshare gapminor violation forgiveaccident forgivenessnot interested

      comprehensive$50 glass deductiblecollisionroadsideloss of use (rental)loan/lease gapincreased custom equiplimited mexico coverageRDP accident/viol forgivePRDP (+dim deducts)new car replacementIntelliDrive savingsnot interested

      comprehensivefull glass $0 deductiblecollisionroadsideloss of use (rental)loan payoffincreased custom equipSnapShot savingsdiminishing deductiblespaperless discountnot interested

      comprehensivefull glass $0 deductiblecollisionroadsideloss of use (rental)accident forgivenessworld-wide rentalloan/lease gapnew vehicle replacementcustom equipemergency assistancerideshare (Uber/Lyft)claims free cash backnot interested

      full glass $0 deductiblenot interested

      full glass $0 deductibleenhanced collisionroadsidetrip interruptionloan/lease gapaccident forgivenesspet injurynot interested

      With regards to life insurance, select all that apply to you.

      How would you rate our service to you?
      below averageaverageabove averagesuperior

      Are there any areas you feel we could improve upon in providing service to you?
      noyes

      We welcome your feedback...

      Share this link with a friend to be automatically entered into our referral program where you can win gift cards and CASH! The more you refer, the more likely you'll win!
      https://wi-insure.com/referrals/

      Please consider leaving us a review here: (link opens new window)
      Leave us a review