Renewal Insurance Information
Patti and Rod would like to Thank you very much for TRUSTING us to help protect your future. We appreciate the confidence you have placed in our Agency. We want you to know that we will do everything possible to serve your insurance needs and to provide the quality of service that our customers expect from a Professional Insurance Agent.

Your insurance policy with us is coming up for renewal. We would like to confirm the information we have so that we can re-quote you with ALL of our carriers to see if we can get you the same or better coverage a the same or lesser price.


Patti Hicks
Office Manager
RC Cook Insurance
330-296-3628

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How Long Have You Lived At Current Address? *
If You Have Lived At Current Address 1 year or Less, Please Provide Your Previous Address:
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Name (Spouse)
If there is no other driver in the household leave Spouse questions blank.
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When was the roof on your home last replaced?
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When was the electrical wiring replaced or updated in your home?
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When was the plumbing replaced or updated in your home?
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When was the HVAC (furnace or A/C) replaced or updated in your home?
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Do you have any pets? if so list with their names and breed.
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Major life event? Have you gotten married, divorced, had a baby or death in the family?
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Do you own land/buildings or cars not insured with us, or did you buy land/buildings or cars in the last 6-12 months?
Are you interested in additional coverage for jewelry, guns, furs, antiques, fine arts, collectibles or silverware.
Do you share your home with a non-related person, boarder, foster child or someone with disabilities or a significant other(boyfriend/girlfriend)?
Have you moved some of your contents to an offsite storage facility?
Have you placed your home, cars or other property in a trust or deeded it to someone else?
Do you own a travel trailer, camper RV, 4-wheeler, boat, motorcycle, airplane?
Are you planning or have already booked an international trip or other family vacation?
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