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.
Start
 
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:
{{answer_6991966}}
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. 
{{answer_6991502}}
{{answer_8100486}}

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.
FiS Home Page
Powered by Typeform
Powered by Typeform