Sutton Insurance_23-0893-00_Personal Lines Renewal Survey

Personal Lines Renewal Survey

Sutton Insurance, Inc.
Name of policyholder(s):
Property Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mailing Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Daytime Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Property
Please list the year each was updated and the type?

Indicate if any of the following apply to the property:

	Yes
Rented or leased to others
Vacant
Unoccupied
For Sale
Under Construction

Do you have one of the following heat sources?

Woodstove Wood Furnace Fireplace Outdoor Woodstove
Are any of the heat sources in an outbuilding?

Yes No
Since your policy was issued have you completed any additions, finished your basement or done any other renovations to your home?

Yes No
If yes, explain:
Is there a trampoline on premises?

Yes No
Is there a pool on premises?

Yes No
If yes, is it above ground or in-ground?

Above Ground In-Ground
If yes, do you have a fence around it?

Yes No
If yes, do you have a locked gate?

Yes No
If yes, is there a slide?

Yes No
If yes, is there a diving board

Yes No
Is there any business or daycare activity at your home?

Yes No
Are you a licensed daycare provider?

Yes No
If yes, how many kids are cared for?

Yes No
If other than daycare, please describe business:
Do you own any recreational vehicles?

Boat Snowmobile ATV UTV Golf Cart Other
Do you have any pets including horses?

Yes No
If yes, what kind/breed?
Do you own any other property (real estate)?

Yes No
Do you own any jewelry valued over $1000?

Yes No
If yes, would you be interested in scheduling the jewelry on your policy to provide broader coverages?

Yes No
Or update any current jewelry scheduled values?

Yes No
Are you interested in scheduling any other items such as guns, collections, fine arts, medical equipment, cameras, computers, etc.?

Yes No
Is the property deeded to a trust or life estate?

Yes No
If yes, Name of Trust?
Would you be interested in increasing your personal liability limits?

Yes No
Would you be interested in Identity Theft Coverage or Home Cyber Protection?

Yes No
Would you be interested in Personal Injury Coverage?

Yes No
Would you be interested in water/sewer backup coverage?

Yes No
Would you be interested in wastewater/service line coverage?

Yes No
Would you be interested in equipment breakdown coverage?

Yes No
Would you be interested in undamaged siding or roofing coverage?

Yes No
Would you be interested in interior matching coverage?

Yes No
Would you be interested in inland flood coverage?

Yes No
Would you be interested in discussing any other optional coverages?

Yes No
Auto/Cycle/ATV/UTV/Snowmobile/Boat

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

	Description of Vehicle
Vehicle #1
Vehicle #2
Vehicle #3
Vehicle #4
Vehicle #5
Vehicle #6
Vehicle #7
Vehicle #8

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)
Do any of your children in high school or college have a 3.0 GPA or above?

Yes No
If yes, which ones?
Do you own any antique or classic vehicles that you would want to insure?

Yes No
Do you own a utility trailer or recreational trailer?

Yes No
Are you interested in a quote with higher liability limits for your vehicle(s)?

Yes No
Would you be interested in having towing coverage or rental reimbursement coverage if you do not have already?

Yes No
Would you be interested in having a $0 deductible for auto glass claims?

Yes No
Are any vehicles used for any type of deliveries or used to transport people for a fee?

Yes No
If yes, please explain:
Do any of your vehicles have a snowplow on them?

Yes No
If yes, which one(s)?
Do you snowplow for a fee?

Yes No
Are any of the vehicles titled to anyone other than the “named insured’s”?

Yes No
If yes, please explain.
Would you be interested in discussing any other optional coverages?

Yes No
Additional Coverages
Would you be interested in quotes for any of the following? Check all that apply.

Automobile Homeowners/Renters Boat ATV/Cycle Snowmobile Flood Umbrella Pet Insurance Business Health Disability Life Annuities/IRA Medicare Supplement
Do you have any other insurance needs that we have not addressed?
Services
How would you rate the services from our agency?

Poor Fair No Opinion Good Excellent
How would you rate your insurance company?

Poor Fair No Opinion Good Excellent
What additional services would you like us to offer?
Would you be interested in setting up any of your insurance policy premiums on a monthly electronic withdrawal directly from your bank to the insurance company to reduce billing fees?

Yes No
Would you like your coverages reviewed by your agent and to learn about new coverages available?

Yes No
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:

Month Day Year
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”.
Please verify that you are human: *
Should be Empty: