Renewal Questionnaire Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Would you like to schedule an in-person review of your policies with our office? *YESNODo we have your permission to recheck your financial/credit score? Credit history is an insurance rating factor, if this score has improved, it may reduce your premium. *YESNOHOMEHave you completed any interior or exterior home renovations in the past 2 years? *YESNOHome renovation details:Do you have any 'other structures' not attached to your home? *YESNOIf yes, select option: *FencingDetached garageShedOutdoor kitchenGazebo or pergolaOutdoor fireplace or water featureHardscapeHot tubSwimming poolOther: provide information belowOther structures details:Do you have a finished basement? *YESNODo you have solar panels? *YESNONumber of solar panels:Do you own a dog(s)? If so, what breed? *YESNOBreedDo you currently, or are you considering renting your home out on a short-term basis(i.e. VRBO, Airbnb)? *YESNOWhen was your roof last replaced? Do you know if the shingle qualifies for a impact resistance rating? *Do you have a water leak detection or automatic water shut-off system? *YESNOWater leak detection systemDo you own any important jewelry, art, coins, or collectibles that you would like scheduled on your policy? *YESNODoes anyone live at your home besides you and your family members? *YESNOAUTODo you ever use your vehicle for ride sharing(Uber or Lift) or business use? *YESNOAre you interested in saving up to 20% on your automobile premiums by participating in monitored driver program? *YESNODo you have any custom or aftermarket equipment or parts on your vehicle? If so, what approximate value? *YESNOApproximate value:Are any of your children living away at college or school? With or without a vehicle? *YESNOWITHWITHOUTDo you own any recreation vehicles, campers, traveler trailers, boats, or motorcycles? *YESNOYear/Make/ModelDo you own an electric or pedal assist bike? *YESNODo you have any antique or collectible vehicles? *YESNOOtherHave you changed jobs recently? *YESNOWhen was the last time you did a thorough review of your life insurance policies? *Would you or a family member be interested in setting up a no obligation 20 minute zoom or phone call with Todd to answer any financial planning questions that may be on your mind? *YESNOT NOW, BUT MAYBE IN THE FUTURENO, THANK YOUHow do you prefer we communicate with you? *PHONEE-MAILTEXTANY OF THESEAnything else you would like to discuss or address at this time?Submit
