Home Renewal Questionnaire Your Name* First Last Your Email* Your Phone*Does the name on your policy match the name on your deed or lease?* Yes No If you have a mortgage, is the mortgage information shown on your current declarations page correct?* Yes No Not Applicable Do you own any water craft?* Yes No Do you: Own any additional property Own any vacant land Rent any portion of your home to others Do you own a golf cart, ATV, or other powered vehicle?* Yes No General Life Changes that may impact insurance (check all that may apply to you or members of your household)* Had a baby Got married or engaged Got separated or divorced Purchased secondary or investment property Someone moved in or out of your household (including child) No Changes Homeowners Insurance Discounts (check all that may apply to you) Fire or Burglar alarm installed (monitored by company such as ADT, Brinks, etc.) Gas alarm installed (such as carbon monoxide alarm or automatic gas main shut-off) Water alarm Non-smoker Storm shutters Fire sprinklers Life Changes that impact Home Insurance (check all that may apply to you)* Completed a home remodel, improvement, or addition Purchased or inherited high value items like jewelry, firearms, or artwork Purchased an outdoor trampoline Began renting out your home, either on a long-term or short-term basis (like Airbnb) Started a home-based business or have a hobby that earns income No Changes Please check any items that are in/on your property in the last 12 months* Dog Trampoline Swimming Pool Other None of the above If you would like to receive quotes for additional types of insurance, please check below: Select All Auto Personal Umbrella Watercraft Golf Cart / Motorcycle Please tell us about any other changes in your household since last policy renewal if any, or any other applicable notes that may help us determine the proper limits of coverage for your auto and/or home insurance policies
