Auto Renewal Questionnaire
Please answer questions below so we can make sure you have the correct coverage and/or discounts available to you.
First Name: *
Last Name: *
Best contact phone number for you? *
Your email address: *
If you don't have one, just put N/A.
1.) Are you sure your current limits for Liability, Uninsured Motorists, Underinsured Motorists, Comprehensive (if any) and Collision (if any), are enough coverage in the event of a serious accident or theft of your car?
Clear selection
2.) Have you had any recent changes in your home address, employment, or marital status?
Clear selection
If so, please list change(s) below:
3.) Please review the lienholder (if any). Do any changes or updates need to be made?
Clear selection
If so, please list lienholder information below:
4.) Do you have any vehicles or drivers in your household NOT listed on your insurance policy or any vehicle not registered in you or your spouse's name?
Clear selection
If so, please list below:
5.) Has a job change, retirement, or use of a different primary vehicle resulted in a change of use of a car such as changing the usage to business use, commuting to and from work less than 15 miles, commuting to and from work more than 15 miles, or pleasure use to a different category?
Clear selection
If so, please list change(s) below:
6.) Do you use any vehicle for your business including snow plowing or pizza delivery?
Clear selection
7.) Do you own any trailers?
Clear selection
8.) Are there any non-residents who frequently use your vehicle?
Clear selection
If so, please explain below:
9.) Do you have any students who are away at school and have a vehicle with them?
Clear selection
If so, please list name(s) and which vehicle(s) below:
10.) Do you have any student drivers with a grade point average of B+ or higher?
Clear selection
If so, please list name(s) and provide current report card(s) to us to submit:
11.) Do you want rental reimbursement coverage, if you are not already covered, in the event your car is damaged in an accident? Up to $30 of coverage per day would cost an average of $20 per vehicle per year.
Clear selection
12.) Do you own the following: primary residence, vacation home, secondary home, condominium, rental property, investment property, boat, jet ski, airplane, snowmobile, recreational vehicle (ATV, go-cart, motorcycle, golf cart, etc.)?
Would you like us to quote any of those items? If so, please list which one(s) below:
13.) Do you own a business not insured by us?
If so, would you like a commercial quote?
Clear selection
14.) Have you filed any claims in the last year?
Clear selection
15.) Would you be interested in an Umbrella Liability policy to protect your assets if you are sued?
Clear selection
16.) If you don't have health and/or life insurance, would you like us to contact you for a quote?
Clear selection
17.) If you would like further review or have questions regarding your policy(s), please let us know when the best time to contact you and your preferred method of contact.
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