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Homeowner Renewal Request
For Help Call 757-481-9105
Fields marked (
*
) are mandatory.
Please Complete the Following Information
Which Company are you currently Insured with?
*
Please select
Erie Ensurance
Safeco Insurance
Allied Insurance Group
AAA
Progressive
Victroria Insurance
CNA Surety
A.I.G.
Hanover(Citizens) Insurance
Fidelity National
F.A.C.T. (Farmers)
Alfa Vision
Deerbrook
Thank you for choosing our agency to service your homeowner insurance needs. Your policy renewal is coming soon and we would like to take a few moments of your time to have you help us complete the following questionnaire.
These questions are intended as a guide for our agency to identify exposures and relevant changes to your insurance situation.
Policy Holder
*
Address
*
City
*
State
*
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
E-Mail
*
1. Do you have or have you added any valuable collections? i.e. Fine Arts, Coins, Jewelry, Guns, etc.
*
Yes
No
If you answered yes to Question #1 please list collection type and estimated value in the area provided below.
Collection Type
Estimated Value
2. Do you keep children or operate a day care in your home?
*
Yes
No
3. Is any part of your home used for business purposes?
*
Yes
No
If you checked yes. Do customers ever come into your home?
Yes
No
4. Do you own a second residence? Vacation Property? Or a Rental Property?
*
Yes
No
Please provide details in the space provided:
5. Do you own any boats, motorcycles, ATV's or any other motorized recreational vehicle?
*
Yes
No
Please provide details in the space provided:
6. Have you made any renovations or additions to you property within the last 5 years?
*
Yes
No
Please provide details in the space provided:
7. Would you like to add identity theft coverage to your policy? ($20 annual charge, please note the attached brochure in the letter you have received in the mail.
*
Yes
No
8. Would you like to receive information on a Personal Liability Umbrella.
*
Yes
No
***Typical cost for a $1,000,000 personal umbrella are less then $200/year. It works out to about $.50 per day.
9. Would you like a quote on any other lines of insurance?
Auto
Life
Business
***Please note when requesting to add coverage, we will contact you. Please do not assume a coverage has been added until it has been confirmed by our agency by phone or email.
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