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Yes |
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No |
| Do you wish to make any changes
to your current coverage amounts? |
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| Is the name on
the policy the same as that shown on your deed? |
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| Is the mortgage information
shown on the policy correct? |
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| Please provide
loan #: |
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| Is your premium paid from your
escrow account? |
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| Do you own any
of the following that exceeds $1,000 in value? |
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| Jewelry: |
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Furs: |
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| Fire Arms: |
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Silver: |
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| Do you own any antiques, fine
art, or collections? |
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| Do you work,
maintain or operated a business, or keep samples
for your business in your home? (Please include
Baby-sitting, lawn mowing, Tupperware, Mary Kay
Etc.) |
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| Do you own any water craft? If
yes please describe: |
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Power/Sail:
HP:
Length: |
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| Do you own any animals? |
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| Description of
Animals: |
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| Do you own any additional
property, vacant, or rent any portion of you
home to others? |
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| Do you own a
golf cart, mini-bike, jet ski, snow mobile or
other powered vehicle not registered or
separately insured? |
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| Does your home have a pool? |
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| Is your pool
fenced? |
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| Does your home have: |
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Smoke Detectors |
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| Dead Bolt Locks |
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Fire Extinguishers |
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| Alarm System |
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Storm Shutters |
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| Your homeowners policy DOES NOT
provide flood insurance. Would you be
interested in a flood insurance cost quotation? |
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| Would you be
interested in a quotation for Life, Mortgage
Protection, Retirement, Health or Disability
insurance? |
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| Please review your current
deductible amount. Would you be interested in a
quotation for a higher deductible? |
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