Home Insurance Renewal Questionnaire
Recent life changes can open up your eligibility for discounts or leave you inadequately covered.  We can help you keep your home insurance up-to-date by conducting an insurance review.

By completing the brief questions below, we can help you assess your needs.
This will take less than 5 minutes.
Name of Individual completing this form: *

Day time phone number where you can be reached: *

Are you currently set up on an automatic payment plan? *

Would you be interested in learning more about different payment options that may offer a discount on your premium? *

Have you made any recent improvements or upgrades to your home? *

Which area of your home has had the improvements or upgrades? *

Alright, you have made updates to the {{answer_8099025}}. 
 I bet it looks nice!
Please include the year, comments and details of the updates. *

Have you recently purchased any of the following or do you need to increase coverage for any of the following not currently on your policy. *

You have selected the following valuable possessions:
Please provide an estimated value for each item: *

Is there any business activity operated out of your home? *

Please describe the type of business being operated. *

Do you have smoke alarms on each floor? *

Do you have a central station burglar alarm? *

Do you have a central station fire alarm? *

Do you have deadbolts on all exterior doors? *

Do you have a fire extinguisher? *

Do you have a wood burning stove or a similar secondary heating unit? *

Do you own one or more rental properties? *

Do you have a pool? *

Please answer the following about your pool.

Is your pool: *

Is your pool fully fenced? *

Is there a diving board? *

Is there a slide? *

Do you have a hot tub? *

Is access to the hot tub: *

Do you have a trampoline? *

Is your yard fenced? *

Do you have dogs on your property? *

We like dogs too!  What breed of dog(s) do you have? *

Please indicate any upcoming changes you expect in the next year:

Please enter any additional comments concerning your insurance, if you have no additional comments, you may skip this question.

Would you like coverage information on any of the following? *

Check all that apply

Excellent, {{answer_6991492}}. Just to confirm, you would like to receive additional information on coverage for: {{answer_8100078}}. 

Please make sure we have your contact information correct so we can follow up appropriately. 

If the information listed above is incorrect, please scroll back to that question to update.
Thank you {{answer_6991492}} for completing this questionnaire about your home insurance renewal.

Your dedicated Agent will be contacting you soon.
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