Your Homeowner's (or Renter's) Renewal Is 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!

    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.

    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

    If so, please explain.

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

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

    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...

    Please provide more details:

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

    Have you purchased any of the following or similar items?

    Have you acquired any pets or livestock?

    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...

    Please provide more details:

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

    Have you considered bundling your autos with your homeowner's?
    yes, I already doyes, please quote meno thanks

    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?

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

    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?

    We welcome your feedback...

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