Annual Review Questionnaire

Primary Phone Number *

Have you done any remodeling, add-ons, outbuilding additions, etc.? *

Do you employ anyone in your home, such as a housekeeper, babysitter, or gardener? *

Do you own any boats, jet skis, or other watercraft? *

Do you own any snowmobiles, golf carts, or other recreational vehicles? *

Do you have any of the following items that you would like to schedule?

Jewelry (exceeding $1,000 total value)
Silverware
Antiques or fine art
Collectibles, such as unique dishes, figurines, do
Guns (exceeding $2,000 total value)
Furs
Camera equipment
Personal computers
More than $200 in money, coins, or stamp collectio

Are you interested in any of the following coverages?

Earthquake coverage
Flood insurance
Personal injury coverage
Refrigerated products coverage

Are you interested in water/sewer backup?

$2,000
$5,000
$10,000

Do you presently have the following in your home?

Deadbolt locks
Fire extinguishers
Smoke detectors

Do you have a security system for your home?

Burglar
Fire
Ambulance

Do you own a second home or any other real property, such as a cabin, farm property or any income producing property? *

Are you presently engaged in any form of farming or ranching? *

Do you conduct any business or give private lessons in your home? (e.g. daycare, office, Avon, etc.) *

Has your mortgage company changed? *

Is this home unoccupied or being rented to others? *

Do you have any of the following?

Swimming pool
Diving board
Trampoline

Do you have any pets? *

Would you like an estimate of your home's replacement cost at today's prices? *

Would you be interested in an umbrella policy that extends your auto and home liability coverage to $1 million or more? *

Do we write your auto insurance? *

If not, can we give you a quote?

What month does your current policy expire?

Do you have any of the following?

Wood burning stove
Traditional fireplace
Freestanding fireplace

Submission Validation

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.