Knight Crockett Miller - Insurance and Financial Consulting company registered in Ohio, Michigan, Tennessee, Florida and Indiana
Knight Crockett Miller Home Contact Knight Crockett Miller Site Map
Review With Us
Haven't looked at your insurance in a while? Complete this review form and make sure your insurance keeps pace with you!

CONTACT INFORMATION
 
Your Name


Street Address


City
State
Zip
Phone - Home


Phone - Work


Phone - Other


Email Address
 
HOMEOWNERS REVIEW
 
Do you own:
 
Antiques:  Yes  No
Cameras:  Yes  No
Collections
(stamps, coins, ...): 		 Yes  No
Fine Arts:  Yes  No
Firearms:  Yes  No
Furs:  Yes  No
Jewelry
(in excess of $1,000): 		 Yes  No
Musical Instruments:  Yes  No

Are any items used professionally?  Yes  No

If you own any of the above items please indicate their value below.
 
Do you have a:
 
Basement:  Yes  No
If so, is it finished?:  Yes  No
Boat:  Yes  No
Camper:  Yes  No
Golf Cart:  Yes  No
Home-based business:  Yes  No
Office in your home:  Yes  No
Recreational Vehicle:  Yes  No
Rental Property:  Yes  No
Seasonal Property:  Yes  No
Snowmobile:  Yes  No
Student away from home:  Yes  No
 

If yes, please provide details:
 
OPTIONS TO CONSIDER:
 
Water Back-Up:
This coverage pays for the damage caused by a back-up of sewer or drains in your basement. Our companies vary in their limit of coverage, so check with us.
Umbrella Coverage:
An umbrella extends your home or auto liability insurance to an additional $1 million. It costs between $150 and $250 a year. Quite a bargin for $1 million!

Would you like to be contacted regarding this option?  Yes  No

Would you like to be contacted regarding this option?  Yes  No


Extended Coverage, Contents:
This coverage will extend the items insured against from a list of twelve to a clause that reads: If it's not excluded, it's covered. This dramatically increases the likelihood of a claim being covered.

QUICK TIP:
Ask yourself the last time you had a claim. If it was more than five years ago, you're wasting money by having a deductible less than $500.
Would you like to be contacted regarding this option?  Yes  No
Would you like to be contacted regarding this option?  Yes  No
 
AUTOMOBILE REVIEW
 
List names of all drivers in your household:

1)

2)

3)

4)

5)

6) 		List all vehicles in your household:

1)

2)

3)

4)

5)

6)
 
 
Do any drivers drive a company car?
 Yes  No
Has any vehicle been customized?
 Yes  No
Do any drivers qualify for a good student discount?
 Yes  No
Are any drivers living away at school without a vehicle? (>100 miles away)
 Yes  No
 
 
OPTIONS TO CONSIDER:
 
Lease/Loan Gap:
For new vehicles only. This coverage makes up for the heavy depreciation applied to new vehicles. Your loan or lease obligation could be more than the car is worth if it is badly damaged in an accident. This coverage files the gap between the current value of the car and its lease/loan cost.
Uninsured Motorists Property Damage:
For roughly $15 a year, you can have coverage to protect your older vehicle against an accident involving an uninsured driver. This coverage pays when your vehicle is damaged by an uninsured driver.

Would you like to be contacted regarding this option?  Yes  No

Would you like to be contacted regarding this option?  Yes  No


Electronic Equipment Coverage:
If your vehicle is equipped with after-market electronic equipment, it isn't automatically covered by your auto policy unless you add this option. Items include after-market CD players, permanently installed car phones, etc...

Customization:
If your vehicle has been customized with spoilers, televisions, special paint jobs, etc..., make sure you let us know. Without identifying a value for these specialties, there is no coverage for them at claim time.

Would you like to be contacted regarding this option?  Yes  No

Would you like to be contacted regarding this option?  Yes  No
 
 
QUICK TIP:
The single most important part of your auto policy is liability coverage. Your limit should be at least $300,000 (or $100,000/300,000.)

Would you like to be contacted to further discuss your insurance program?  Yes  No
 


Thank you for your continued business.
We look forward to servicing your account for years to come.
Image verification

Please enter the text in the image above. This is to prevent our form from getting spammed.

 



Home Pay Your Bill Account Login Report a Claim Certificate of Insurance Get a Driving Record Get an Auto ID Card Ask an Agent
KCM Gives Back Celebrate With us!
Careers Agency History Annual Reports About Us
Home  |   Contact  |   Business  |   Home & Auto  |   Financial  |   Health
Pay Your Bill  |   Account Login  |   Report A Claim  |   Proof of Insurance  |   Get a Driving Record  |   Get an Auto ID Card  |   Ask An Agent
22 N Erie Toledo, OH 43604 | p - 419 241 5133 | f - 419 321 5280 | tf - 800 241 5133
Website Design & Maintenance by Toledo.com. Copyright 2010 Knight Crockett Miller Insurance Group. All Rights Reserved.
Privacy Policy