Renewal Checklist Full(Required) First Middle Last Email Address Best Phone Number for Follow Up DiscussionBest time to call Has your phone number or email address changed? Yes No Home & Liability Umbrella Would like a review of my current home replacement cost value Additional residences coverage on a second home, investment property, farm property, or land with a structure on it Remodeled, put on an addition, updated, or changed the value of my home Operate a business or daycare in my home Change in marital status Check all that may applyOptional home coverages. Let's Discuss... Flood insurance Earthquake coverage Scheduled personal property valuable jewelry, furs, fine arts, firearms, collectibles, antiques, silverware, stamps, or coins Sewer or drain backup coverage water that backs up through sewers and drains or that overflows from a sump pump Identity theft coverage Umbrella liability additional liability coverage for home, auto, and other exposures in increments of $1 million Check all that applyYou may be able to reduce your homeowner's premium Recently retired or other permanent change in employment Installed a centrally monitored alarm system in your home Increase homeowner's deductibles Check all that applyAuto Coverages and Drivers Purchased or sold any vehicles Added or removed any drivers Change in commute distance or status Purchased or sold any recreational vehicles, such as watercraft, camper or motor home, motorcycle, ATV, snowmobile, golf cart Check all that applyOptional auto coverages. Let's Discuss... Increase uninsured/underinsured motorist coverage limits Special equipment installed on my vehicle Electronic equipment in my vehicle that was not factory installed or permanently attached Rental car reimbursement Towing and labor Check all that applyYou may be able to reduce your auto premium Good Student Discount provide a copy of the child's report card with a B average or above Drive a company vehicle as a primary mode of transportation Child in college who did not take a vehicle with him/her and is over 100 miles away Vehicle over eight years old consider eliminating collision and/or comprehensive coverage Increase your comprehensive and/or collision deductibles Check all that applyAdditional Comments or SuggestionsBinding Agreement - I understand that any policy changes and quote requests are effective only when I have received a written confirmation.(Required) I agree
