The purpose of the form is to make sure your insurance program is up to date with your life.  The questions are designed to address the areas that change most frequently.  Please take a moment to answer these questions.

 

 Name 
 Email  
 Phone 

 How would you prefer to be contacted?     Phone  E-mail  Traditional Mail

Review Your Home

 

 Improvements or Updates  Have you added a porch, deck, garage, room
 addition, or the like?Yes No
 If so please explain the improvement and its approximate cost

 

 Business Exposure.  Do you run any kind of business out of your home?
 (Avon,Pampered Chef, computer service, etc.)  Yes No
 If so please describe

 

 Do you own any other properties that we do not insure? Yes No
 If so please provide the address (include city, state, zip)
 

Check Your Coverages

 The preferred policy of today includes the following coverages.  Review the 
 coverages below to see if your policy contains all of these coverages.  Phone 
 or email us to discuss your specific policy.

Replacement Cost on Dwelling.  This coverage protects you in the event your dwelling limit is insufficient to rebuild your home.  We will pay up to 125% of the dwelling limit (percentage depends on company).
Replacement Cost on Contents.  This coverage removes the depreciation clause from your policy.  As an example, your ten-year-old dishwasher would not be depreciated if it were damaged in a covered loss.  We would pay what it costs to buy a comparable dishwasher today.
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.
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.
Umbrella.  An umbrella extends your home or auto liability insurance to an additional $1 million.  It costs between $150 and $250 a year.  Quite a bargain for $1 million!
$500 Deductible.  Ask yourself the last time you had a claim.  If it was more than five years ago, you're wasting money by paying for a deductible less than $500.

Review Your Autos

 List the current drivers, the vehicles they drive, and how many miles driven one way each day:

Driver Vehicle Miles/day

 Any vehicles in storage during the year? (It will save you money!) 

 If you have young drivers, take note to these cost-saving questions:
         Do they qualify for a good student discount (GPA 3.0 or better)?  Yes No
         Are they away at school without a car?  Yes No
         Do they share a vehicle with another driver?  Yes No

 Are any autos older than 1989 still carrying full coverage?  Consider removing
 collision coverage.  Call to discuss.

 Are your deductibles less than $250 on comprehensive and $500 on collision?
 If so, consider increasing to these levels.
 The price savings may surprise you.

Check Your Coverages

 Following are some optional coverages that may be important to you.  Take a look and phone us if you want further information.

Liability Limit.  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).
Lease/Loan Gap.  For new vehicles only.  This coverage makes up for the heavy depreciation applied to new vehicles.  Your loan or lease could be more than the car is worth if it is badly damaged in an accident.  This coverage fills 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 insured driver.  This coverage pays when your vehicle is damaged by an uninsured driver.
Electronic Equipment Coverage.  If your vehicle is equipped with after-market electronic equipment, it isn't covered by your auto policy unless you add this coverage.  Items such as after-market CD players, permanently installed car phones, etc., are affected.
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 specialities, there is no coverage for them at claim time.

If you have any additional questions or comments please include them below.

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