Account Review Protecting What Matters Most! Auto Policy ChecklistHomeowners Policy ChecklistRiskMap Coverage Review Five minutes of your time to complete this questionnaire will help eliminate claims problems. Name:*Date:* MM DD YYYY Phone:*Email:* Have you acquired any new vehicles not listed on your auto policy?*YesNoWould you like for your policy to cover a rental vehicle if you are involved in an accident?*YesNoAre any vehicles NOT titled in you or your spouse's name?*YesNoIs anyone living in your household without a valid driver's license?*YesNoDo you have anyone living in your household that has a driver's license but does not have an insurance policy?*YesNoIf you had an accident that resulted in a death to the other party, and you were sued for $1.2 million, would you want your insurance policy to cover paying this judgment for you?*YesNoIf you own a pickup or van, does it contain customized equipment, camper, or cap?*YesNoDo you own a mini-bike, moped, or motorized scooter?*YesNoDo you own an ATV, snowmobile, camper, motor home, or trailer?*YesNoDo you have any students away at school?*YesNoHave you changed jobs that would result in either an increase or decrease in the distance you drive?*YesNoAre there any non-household residents who frequently use your vehicle(s)?*YesNoIf you have children driving, would they qualify for a good student discount (3.0 or higher GPA)?*YesNoDo you have any older vehicles that should be considered for liability only coverage?*YesNoNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. Five minutes of your time to complete this questionnaire will help eliminate claims problems. Name:*Date:* MM DD YYYY Phone:*Email:* Have you remodeled your home, added any additions, a deck or porch, built an outbuilding or detached garage, or remodeled/finished your basement?*YesNoIs your house currently for sale or vacant?*YesNoDo you have a wood stove in your home?*YesNoHave you acquired any valuables or collectables, like, guns, jewelry, computers, and/or electronics, not listed on your policy?*YesNoAre you currently living in your house, versus it being vacant or rented to others?*YesNoIf your sump pump over flows or sewage backs up in your basement, would you want your homeowners policy to pay for the cleanup and damage to your property?*YesNoIn the event of a total loss to your home, do you want your insurance company to guarantee FULL replacement no matter what your policy limit is?*YesNoAre your premises free of miscellaneous and/or dangerous debris?*YesNoDo you own a snowmobile, camper, motor home, or trailer?*YesNoDo you own any ATVs, boats, snowmobiles, or other recreational vehicles that are not listed on your policy?*YesNoWould it cost more to rebuild your home than what it is currently insured for?*YesNoIf someone slipped and fell on your property which resulted in a lawsuit for $900,000 would you like your insurance company to pay the judgment and court costs for you?*YesNoDo you have any dogs or exotic pets?*YesNoWould you consider increasing your deductible to lower your premium?*YesNoIs there a trampoline or swimming pool in your yard?*YesNoDoes your home have circuit breakers?*YesNoIs your plumbing completely PVC and/or Copper piping?*YesNoHow old is the roof on your home?*Please enter a value greater than or equal to 1.How old is your furnace?*Please enter a value greater than or equal to 1.What year was your home built?*How many acres does your home sit on?*Please enter a value greater than or equal to 1.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. Please fill in the personal information below, then check each box of each item you are interested in learning more about. We will reach out to you shortly after you complete the form. Name:* First Email:* Phone:*ZIP / Postal Code:* ZIP / Postal Code Please select the items you would like more information about: Umbrella Catastrophic Liability Protection Protects your family from losing everything that you have worked so hard for if sued for an accident on your premises or while driving your car. Life Insurance Protection With Life Insurance premiums at all-time lows, there is no better time to protect your family’s future. Sewers/Drain Back Up Provides coverage to clean-up and repair damage caused by sewer/drain back up in your home. Earthquake/Flood Most standard homeowners policies do not cover damages due to earthquake or flood hazards. Ordinance & Law Coverage Provides you coverage for the extra cost incurred to meet new law and ordinance codes in the event you have to re-build your home. 100% Guaranteed Replacement Cost In the event of a total loss to your house, this coverage ensures that the entire cost to rebuild will be covered, even if it is beyond the policy limit. Road Side Assistance Provides reimbursement for towing and labor fees in the event you get stranded from a car breakdown. Rental Reimbursement Provides reimbursement if you need to rent a car while your vehicle is in the repair shop due to a covered loss. Electronic Funds Transfer (EFT) Payments Ensures your payment is not lost or held up in the mail. Multi Package Discounts You receive the best cost saving premiums if you package all of your insurance policies together.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.