Sutton Insurance_23-0893-00_Personal Lines Renewal Survey

Indicate if any of the following apply to the property:

Please list all vehicles/units that should be on your policy:

Please list all drivers and household members 13 and older and note which vehicle # driven primarily (if a new driver, we need name, date of birth & driver’s license number)
YesNo
If yes, which ones?
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If yes, please explain:
YesNo
If yes, which one(s)?
YesNo
YesNo
If yes, please explain.
YesNo
Additional Coverages
AutomobileHomeowners/RentersBoat ATV/CycleSnowmobileFloodUmbrellaPet InsuranceBusinessHealthDisabilityLifeAnnuities/IRAMedicare Supplement
Do you have any other insurance needs that we have not addressed?
Services
PoorFairNo OpinionGoodExcellent
PoorFairNo OpinionGoodExcellent
What additional services would you like us to offer?
YesNo
YesNo
If so, when is a convenient time?
Any additional comments:
* Always review your renewals and changes to make sure everything has the coverage that you want. Never hesitate to call our office with any questions or concerns.
Your Name:
Your Signature:

Clear
Date:

MonthDayYear
Date
Thank you for taking the time to complete this survey. We appreciate your business. Tarah, Sally or Carlee will be contacting you to discuss further any items answered “yes”.
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