Homeowner Insurance Review

Business Activities

Are there any business activities operated out of your home?

Enter comments or details on any business activities below:

Improvements or Upgrades

Were there any recent improvements or upgrades to your home?

Enter comments or details on any improvements or upgrades below:

PERSONAL PROPERTY

Do you own or lease any of the following?
Include items we may already insure plus any new items recently acquired.

NONE
Boat
Art / Collectibles
Jewelry / Silverware / Furs
Computer and software
Snowmobile / Golf cart / Other recreational vehicle

Enter comments or details on any valuable possessions below:

OUTSIDE ACTIVITIES

Are you or members of your family active as a ...
NOT ACTIVE IN ANY OF THE FOLLOWING
Committee member
Board member
Sports team coach / Umpire / Organizer / Fund Raiser

Enter comments or details on your personal activities below:

DISCOUNTS

Check off the home insurance discounts to which you believe you're entitled:

New home credit - For homes built within the last 8 years.
Masonry construction credit
Long-term policyholder credit - Applies when you've had a policy with same company for X years.
Long-term Credit - Applies when you've gone without an auto claim for 5 consecutive years.
Home & car credit - Discounts off each policy when both are with the same company.
Interior sprinkler system

Alarm device credit - Discounts vary by type of device(s) installed. Which do you have?
Smoke detectors on each floor
Smoke detectors + deadbolts on all outside doors + fire extinguishers
Local burglar alarm
Central station burglar alarm
Local fire alarm
Central station fire alarm

MISCELLANEOUS INFORMATION

Check the following boxes only if your answer is YES ...

I have a wood-burning stove or similar secondary heating unit.
I employ domestic help. [Maid, gardener, etc.]
I own one or more rental properties.

Enter comments regarding the above or on any other topic:

EXTRA PROTECTION

Check off the extra coverages on which you would like information:

Identity-Theft Insurance
$1,000,000 Umbrella Policy (or higher)
Flood Insurance
Low-cost Term Life Insurance
Retirement Planning / College Funds
Health insurance / Personal income protection
Business insurance

YES! I am interested in information on the above protection. Please contact me by:

Email Regular Mail Phone [Enter details below]

Form Completed By:

Thank you for taking the time to complete this online review. Its purpose is to assist us in determining if your automobile insurance needs some fine tuning to match up with the current conditions in your life. We promise to get back to you shortly.