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Home Insurance Questionnaire

We recommend a home insurance update for all of our clients every year. This questionnaire makes the review quick and efficient and alerts us to any coverage needs you may have. Please take a moment to answer the following questions then depress "Submit" at the bottom. (* denotes required information)

*Name			*EMAIL
*Home Phone			Business Phone
Address			Town
State			Zip

Please answer yes or no.

Do you own a watercraft, golf cart, ATV, moped, or other motorized vehicle?		Yes No
Have you paid off a mortgage or had a change in mortgage company recently?		Yes No
Do you have any protective devices such as central burglar or fire alarm?		Yes No
Do you own a vacation property or other property, such as vacant land or rental properties?		Yes No
Do you operate any home-based or part-time business activities from your home?		Yes No
Do you have any detached structures on your property? (e.g. tool shed, detached garage)		Yes No
Do you have children attending school away from home?		Yes No
Do you have a swimming pool?		Yes No
Are you near a water source other than a swimming pool?		Yes No
Do you own any fine arts, antiques, or other unique items?		Yes No
Do you own jewelry, furs, silverware, valuable camera equipment, guns, or musical equipment?		Yes No
Do you travel outside the U.S., its territories, or Canada?		Yes No
Flood and earthquake insurance are available. May we give you a proposal for these coverages?		Yes No
Our Homeowners companies offer identity theft coverage. Would you like to talk with us about Identity theft coverage?		Yes No
We offer life insurance, disability income, long-term care. May we provide you a proposal?		Yes No
Does anyone in household serve as a board member or a volunteer to a non-profit organization?		Yes No
Have you improved your home with an addition or do you plan to add to your home within the next 6 months?		Yes No