Renewal Questionnaire

Name

First

Last

Email

Phone

Would you like to schedule an in-person review of your policies with our office?

YES
NO

Do 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.

YES
NO

Have there been any significant life changes since you last reviewed your estate plan?

YES
NO
I don't have an estate plan and would like help in this area

Please explain the changes:

HOME

Is your home titled in the name of a trust?

YES
NO

Please provide the name of the trust:

Have you completed any interior or exterior home renovations in the past 2 years?

YES
NO

Home renovation details:

Do you have any 'other structures' not attached to your home?

YES
NO

If yes, select option:

Other structures details:

Do you have a finished basement?

YES
NO

Do you have solar panels?

YES
NO

Number of solar panels:

Do you own a dog(s)? If so, what breed?

YES
NO

Breed

Do you currently, or are you considering renting your home out on a short-term basis(i.e. VRBO, Airbnb)?

YES
NO

When 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?

YES
NO

Water leak detection system

Do you own any important jewelry, art, coins, or collectibles that you would like scheduled on your policy?

YES
NO

Does anyone live at your home besides you and your family members?

YES
NO

AUTO

Do you ever use your vehicle for ride sharing(Uber or Lift) or business use?

YES
NO

Are you interested in saving up to 20% on your automobile premiums by participating in monitored driver program?

YES
NO

Do you have any custom or aftermarket equipment or parts on your vehicle? If so, what approximate value?

YES
NO

Approximate value:

Are any of your children living away at college or school? With or without a vehicle?

YES
NO
WITH
WITHOUT

Do you own any recreation vehicles, campers, traveler trailers, boats, or motorcycles?

YES
NO

Year/Make/Model

Do you own an electric or pedal assist bike?

YES
NO

Do you have any antique or collectible vehicles?

YES
NO

Other

Have you changed jobs recently?

YES
NO

When 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?

YES
NOT NOW, BUT MAYBE IN THE FUTURE
NO, THANK YOU

How do you prefer we communicate with you?

PHONE
E-MAIL
TEXT
ANY OF THESE

Anything else you would like to discuss or address at this time?

SMS

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Thoughtful Protection for Exceptional Assets

Insurance Renewal Questionnaire

HOME

AUTO

Other