Personal Renewal Review Please complete the information below and remember we are always here to answer your questions. Contact Information First Name* Last Name* Email Address* * required fields Let's say you were driving to work tomorrow, had an accident, you were at fault, and there was $100,000 in damages - would you want your policy to pay all damages? Yes It's not something I am concerned about Let's say you had a few glass claims, would you prefer to pay for them out-of-pocket, or would you prefer for your insurance premiums to go up? Pay for them out of pocket Rather pay a higher premium and have it covered If you had damage to your car, would you rather have a lower deductible for less out-of-pocket, or would you prefer to lower your premiums by choosing a higher deductible? I would rather have a lower deductible I would rather reduce my premiums How many licensed drivers are in your household? In the event of death, would you want loans on any of your vehicles paid? Yes No Homeowners Do you have any jewelry you would want replaced if it were lost on vacation? Yes No If you had damage to your home, would you rather have a lower deductible for less out-of-pocket, or would you prefer to lower your premiums by choosing a higher deductible? I would rather have a lower deductible I would rather reduce my premiums Have you made any improvements or additions to your home over the past year? Yes No If you had a sewer backup and your carpet were ruined, would you want it replaced? Yes It's not something I am concerned about In the event of death, would you want the mortgage on your home paid? Yes No I do not have a mortgage Recreational Vehicles Do you have any licensed vehicles such as boats or snow mobiles that you would want replaced in the event of an accident? Yes No General Questions Do you have any income producing hobbies? Yes No Do you have any collections, such as guns or art? Yes No Do you have a vacation home or rental properties? Yes No Do you have an inventory of all your household possessions? Yes No Do you do any work at home for your employer? Yes No Have you made any major purchases during the past year? Yes No Have you added a burglar alarm or other security devices? Yes No If you live in an area frequented by flood, earthquakes or earth movement, would you want losses covered for these disasters? Yes It's not something I am concerned about Let's say you were involved in an accident in your car, or someone hurt them selves on your property, and you were sued for $1,000,000. Where would you want the money to come from? My insurance policy It's not something I am concerned about If you had a chronic illness or disability that left you unable to care for yourself for an extended period of time, where would the money come from? I don't know It's not something I am concerned about Other Policies In order to properly protect your assets, it is important that we have complete information about your total account. Please list any policies, including personal auto, homeowners and group health, written with other agents. Feedback Has anyone in our office provided exceptional service over the last year. If yes, please tell us about it. If we have provided value to you over the last year, we might also be able to help your friends and neighbors. Who would you suggest we contact? Click here to view Terms & Conditions I have read the terms & conditions and I agree to be bound by those terms and conditions Back to Request A Quote