Homeowners, Wind, and/or Flood Insurance Courtesy Renewal Questionnaire
To assist us in protecting you against possible uninsured losses, and to keep our information as current as possible, please complete the following questionnaire. These will be sent 60 - 90 days prior to your renewal date for each policy.
Name
*
First Name
Last Name
Todays Date
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you made any improvements or renovations to your home since you last reviewed the coverage amounts on your policy?
*
Yes
No
Please Advise:
*
Has the occupancy changed?
*
Yes
No
Please Advise:
*
Is the name(s) on your policy the same as that shown on your deed?
*
Yes
No
If you have a mortgage, is the mortgage information shown on your current declarations page correct
*
Yes
No
N/A
Name of Mortage Company
*
Their Address
*
Loan #
*
Who Pays your insurance premium and should get the bill?
*
Mortgagee/Bank
Insuranced/Self Pays
If you own over $1,000 worth of Jewelry, Furs, Firearms,silver, silverware, goldware, china, etc. these items may not becovered properly under your home insurance policy. Would you like aquote for this valuable coverage?
*
Yes
No
If you own any antiques, fine arts or collections, the items may not be covered properly under your home insurance policy. Would you like a quote for this valuable coverage?
*
Yes
No
Do you work, maintain or operate a business, or keep samples for your business in your home? (Please include baby-sitting, lawn mowing, Tupperware, Mary Kay, etc.)
*
Yes
No
Would you like information on wind mitigation credits?
*
Yes
No
Do you own any animals?
*
Yes
No
Describe type and/or breed
*
Does your home have a pool? *Note: If you live at an association, you do not need to include pool.*
*
Yes
No
Is it fenced or screened?
*
Yes
No
Do you own any additional property (whether or not in the State of Florida), vacant land, or rent any portion of your home to others (include home sharing services like Air B & B)?
*
Yes
No
Do you own a golf cart, go cart, mini-bike, jet ski, snow mobile or other powered vehicle not registered or separately insured?
*
Yes
No
Do you own any water craft?
*
Yes
No
Power / Sail
*
HP
*
Length
*
Do you own a golf cart, go cart, mini-bike, jet ski, snow mobile or other powered vehicle not registered or separately insured?
*
Yes
No
Please review your current deductible amount. Would you be interested in a quotation for different deductible?
*
Yes
No
Please indicate which you would like the quote for:
*
Increased Deductibles
Decreased Deductible
Does your home have A Monitored Fire Alarm System
*
Yes
No
Does your home have A Monitored Burglar Alarm System
*
Yes
No
Does your home have Fire Sprinklers inside
*
Yes
No
Does your home have Storm Shutters
*
Yes
No
Does your home have Circuit breakers
*
Yes
No
Does your home have a Fuse box
*
Yes
No
Your homeowners policy DOES NOT provide flood insurance. Would you be interested in a flood insurance quotation if you do not currently have a flood policy? (Remember, you can still purchase flood insurance even if you are in a low-risk zone.)
*
Yes
No
If you have flood insurance coverage already but the limits in the policy are not adequate to replace the structure and/or personal property after a covered loss, would you like a quote for Excess Flood Insurance coverage?
*
Yes
No
Would you be interested in a quote for Umbrella Liability?
*
Yes
No
Would you be interested in a quote for policy that will eliminate your hurricane deductible?
*
Yes
No
Would you be interested in a quotation for any of the following: (click all of intrest)
*
Life
Retirement
Health
Disability
None of the Above
Would you be interested in a comparative auto insurance quote to to help save additional money?
*
Yes
No
Submit
Should be Empty: