Your Home & Auto Renewals Are Coming Up!

Emily Smith, CSR/Agent

You are a valued client and we are constantly striving to find creative and innovative ways of delivering excellent customer service to you.

Because life changes,  your insurance needs change too and we feel it’s very important to check with you regularly to make sure we have up-to-date information to ensure you’re properly covered.

We have a very short questionnaire for you to complete. It should only take about 2-3 minutes to complete and will greatly help us keep your info up-to-date. Thanks for your cooperation and participation!

Facebook Twitter Instagram Youtube

    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

    Is there any business personal property on premises or any business operations conducted on premises?
     ex: work-provided computer, home office, in-home daycare, music lessons, etc..
    yesno

    Please explain

    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 backupearthquakemine 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

    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:

    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