First Name |
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Last Name |
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Address |
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City |
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State
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Zip
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Day Time Phone |
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Night Time Phone |
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Best Time to Call |
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Email Address |
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If you were involved in an accident resulting in more than $100,000 in property damage, would you want your auto policy to cover this? |
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If your vehicle was involved in an accident would you rather pay a lower deductible and higher premius, or choose a higher deductible to help maintain lower premiums? |
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How many occupants over the age of 16 in your household? |
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If a member of your household was involved in an accident resulting in death, would you want any loans on your vehicles and your home to be paid off? |
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Do you have any jewelry, fine art, collectibles, guns, etc that you would want covered in the event of a loss? |
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Are you interested in coverage that would protect you against identity theft? |
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Are you interested in back up of sewers and drains coverage |
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Homeowners premiums can be lowered by selecting higher deductibles. Is this something you would be interested in? |
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In the last year have you made any improvements or added any additions to your dwellin? |
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Do you have boats, snowmobiles, or other recreational vehicles you would like covered? |
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Do you have a home based business producing income? |
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Do you own any other dwellings?
If yes, explain. |
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What amount of insurance do you feel would be sufficient to cover all of your personal belongings (not including the structure) in the event of a total loss? |
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Have you added a burglar alarm or other security devices in the past year.
If yes please explain. |
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Would you want coverage in the event of an earthquake? |
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If you were held liable and expected to pay damages in the amount of $1,000,000 for something that could have been covered by insurance, would you want that coverage? |
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Are you interested in a disability policy that would help coverage your expenses in the event that you were unable to work for a period of time? |
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