The Region Renewal Form
Name
First Name
Last Name
DISCOUNTS
Here we will ask several questions to make sure you are receiving every discount that we can potentially get for you on your policy.
Do you have any children on your policy and in school (including college) right now?
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Yes, I have children that are in school on my policy.
No, I do not have any children that are in school on my policy.
Great! Does your child(ren) have good grades (3.0 GPA or better)?
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Yes, their GPA is over 3.0
No, their GPA is over 3.0
Is your child(ren) away at college?
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No, they are not in college yet.
Yes, they are living at or near their college (not at home).
Does your child(ren) have one of the vehicles on your policy with them at college?
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Yes, they have a vehicle.
No, they do not have a vehicle.
Would you be interested in a telematics discount? This is a device or app that monitors your driving habits to give you a discount.
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No, I'm not interested in this discount.
Yes, I'd like to discuss it.
I already have the telematics discount on my current policy.
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POLICIES & COVERAGE
Here we will ask a few questions to make sure you are properly covered.
What insurance policies do you have now (even if they're not with our agency)?
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Auto
Home (you own your home)
Renters (you rent your home)
Rental Property (you own a home that someone else lives in)
Motorcycle / ATV / Camper / Trailer / Boat / Other Toy
Commercial / Business Policies
Umbrella (excess liability)
Here are some common auto insurance optional coverages. Please check all that you would be interested in adding to your policy. By not selecting them, you are declining any of these coverages that are not on your policy now.
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Towing / Roadside
Rental
Windshield Coverage ($0 deductible for glass claims)
New Car Replacement / Gap Coverage
Customized Vehicle / Aftermarket Improvements Coverage
Rideshare Coverage (required if driving for Uber, Lyft, DoorDash, etc)
Here are some common home insurance optional coverages. Please check all that you would be interested in adding to your policy. By not selecting them, you are declining any of these coverages that are not on your policy now.
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Equipment Breakdown (coverage for breakdown of appliances, furnace, AC, etc)
Sewer / Water Backup (highly recommended if you have a basement)
Service Line Coverage (coverage for service lines between the street and the house)
Extra coverage for jewelry, firearms, and other collectibles
Earthquake Coverage (commonly excluded in Indiana home policies)
Flood Coverage / Flood Policy (commonly excluded in Indiana home policies)
Guaranteed Replacement Cost (home is guaranteed to be rebuilt in the event of a total loss)
Have you had any roof work done in the last 5 years?
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Yes, we have had roof work done within the last 5 years.
No, we have not had roof work done within the last 5 years.
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Is there anything specific that you'd like to discuss during this review? (NOT REQUIRED)
If there isn't anything specific you'd like to go over, you can skip this question.
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THANK YOU FOR YOUR BUSINESS!
We will now bring you to our calendar where you can schedule a time to go over the policies. YOU MUST SCHEDULE A TIME SLOT FOR A COMPLETE RENEWAL REVIEW.
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