Home	Contact us	Free Coffee	Insurance 101	Useful Links
FAQ's	About Us	Glossary	Directions	Insurance Review

Insurance Review

Name: Telephone Number:

Address:
City: State: Zip:

Homeowner’s Review:

1) Have you remodeled your home? Added Decks? Hot Tubs? Additions? Porches? Upgrades?	Yes No
2) Have you added a Security System?	Yes No
3) Do you have expensive jewelry, Furs, Guns, Antiques, Collectibles, Fine Arts?	Yes No
4) Have you done an inventory in writing or video of your home and belongings?	Yes No
5) Is Identity Theft a concern?	Yes No
6) Do you want Flood or Earthquake Insurance?	Yes No
7) Do you want Back up of Sewer Coverage?	Yes No
8) Do you Operate any sort of Business from your Home? Baby-Sitting? Music Lessons? Construction/Landscaping? Home party representative?	Yes No

Auto / Vehicles Review:

1) Do you have a car phone, CB or Stereo in any of your vehicles?	Yes No
2) Do you own any Motor Homes, Campers, Travel Trailers, Boats, Mini-Bikes, Mopeds, Snowmobiles, Motorcycles, or Golf Carts?	Yes No
3) Do you have any cars in the household furnished for your use by others? i.e. Business cars	Yes No
4) Do you need coverage for rental reimbursement and towing if you are involved in an accident?	Yes No
5) Did any youthful drivers have a grade point of B or better the last grading period? Are any away at school?	Yes No
6) Are the drivers & autos listed on the policy up to date?	Yes No

Liability Review:

1) Do you or any family members serve on any Board of Directors?	Yes No
2) Do you have a need for any Professional Liability Coverage?	Yes No
3) Do you now own Rental Property?	Yes No
4) Do you need a personal Umbrella Policy?	Yes No
5) Do you now own your own Business?	Yes No

Estate, Health & Life Insurance Review:

1) Have you reviewed your Will recently? Are the guardians still appropriate?	Yes No
2) Have you developed a plan for education needs & retirement? For Estate Planning?	Yes No
3) Do you need Long Term Disability Protection?	Yes No
4) Have you reviewed the life insurance on yourself or other family members? Children? Grandchildren?	Yes No
5) Are you interested in any Financial Services?	Yes No
6) Do you need information on Health Insurance? e.g. Health coverage for a recent graduate? Medicare supplements? Long term Plans?	Yes No
7) Have you thought about refinancing, taking out a home equity or auto loan?	Yes No

Thank you for completing this questionnaire.
Please Press the Submit button to send your information.