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

CityState / Province

Postal / Zip Code
Mailing Address:

Street Address

Street Address Line 2

CityState / 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?

WoodstoveWood FurnaceFireplaceOutdoor Woodstove
Are any of the heat sources in an outbuilding?

YesNo
Since your policy was issued have you completed any additions, finished your basement or done any other renovations to your home?

YesNo
If yes, explain:
Is there a trampoline on premises?

YesNo
Is there a pool on premises?

YesNo
If yes, is it above ground or in-ground?

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

YesNo
If yes, do you have a locked gate?

YesNo
If yes, is there a slide?

YesNo
If yes, is there a diving board

YesNo
Is there any business or daycare activity at your home?

YesNo
Are you a licensed daycare provider?

YesNo
If yes, how many kids are cared for?

YesNo
If other than daycare, please describe business:
Do you own any recreational vehicles?

BoatSnowmobileATVUTVGolf CartOther
Do you have any pets including horses?

YesNo
If yes, what kind/breed?
Do you own any other property (real estate)?

YesNo
Do you own any jewelry valued over $1000?

YesNo
If yes, would you be interested in scheduling the jewelry on your policy to provide broader coverages?

YesNo
Or update any current jewelry scheduled values?

YesNo
Are you interested in scheduling any other items such as guns, collections, fine arts, medical equipment, cameras, computers, etc.?

YesNo
Is the property deeded to a trust or life estate?

YesNo
If yes, Name of Trust?
Would you be interested in increasing your personal liability limits?

YesNo
Would you be interested in Identity Theft Coverage or Home Cyber Protection?

YesNo
Would you be interested in Personal Injury Coverage?

YesNo
Would you be interested in water/sewer backup coverage?

YesNo
Would you be interested in wastewater/service line coverage?

YesNo
Would you be interested in equipment breakdown coverage?

YesNo
Would you be interested in undamaged siding or roofing coverage?

YesNo
Would you be interested in interior matching coverage?

YesNo
Would you be interested in inland flood coverage?

YesNo
Would you be interested in discussing any other optional coverages?

YesNo
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?

YesNo
If yes, which ones?
Do you own any antique or classic vehicles that you would want to insure?

YesNo
Do you own a utility trailer or recreational trailer?

YesNo
Are you interested in a quote with higher liability limits for your vehicle(s)?

YesNo
Would you be interested in having towing coverage or rental reimbursement coverage if you do not have already?

YesNo
Would you be interested in having a $0 deductible for auto glass claims?

YesNo
Are any vehicles used for any type of deliveries or used to transport people for a fee?

YesNo
If yes, please explain:
Do any of your vehicles have a snowplow on them?

YesNo
If yes, which one(s)?
Do you snowplow for a fee?

YesNo
Are any of the vehicles titled to anyone other than the “named insured’s”?

YesNo
If yes, please explain.
Would you be interested in discussing any other optional coverages?

YesNo
Additional Coverages
Would you be interested in quotes for any of the following? Check all that apply.

AutomobileHomeowners/RentersBoat ATV/CycleSnowmobileFloodUmbrellaPet InsuranceBusinessHealthDisabilityLifeAnnuities/IRAMedicare Supplement
Do you have any other insurance needs that we have not addressed?
Services
How would you rate the services from our agency?

PoorFairNo OpinionGoodExcellent
How would you rate your insurance company?

PoorFairNo OpinionGoodExcellent
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?

YesNo
Would you like your coverages reviewed by your agent and to learn about new coverages available?

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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