Skip to the content
Insurance Services
Auto, Home & Personal Insurance
Auto Insurance
Boat & Marine Insurance
Condominium Insurance
Flood Insurance
Homeowners Insurance
Motorcycle Insurance
Renters Insurance
- View All Personal
Business Insurance
Business Interruption Insurance
Business Owners Package Insurance
Commercial Auto Insurance
Commercial Property Insurance
Commercial Umbrella Insurance
General Liability Insurance
Manufacturers Insurance
Professional Liability (E&O) Insurance
Surety Bonds
Workers' Compensation Insurance
- View All Business
Life Insurance
Individual Life Insurance
Fixed Annuities
- View All Life
About Us
Customer Reviews
Our Insurance Carriers
Insurance Blog
Policy Service
Online Billing & Payments
File A Claim
Auto ID Card Request
Certificate of Insurance Request
Policy Change Request
Insurance Resources
Contact Us
Plains Office
Secure Contact Form
Refer a Friend
Home
>
Personal Insurance Checklist
Personal Insurance Checklist
Personal Information
Name
*
E-mail Address:
*
Address
*
Street Address
City
*
State
*
Zip Code
*
Phone:
*
Best Time to Call:
9:00am – 12:00pm
12:00pm – 3:00pm
3:00pm – 6:00pm
Checklist Questions
1) Do you have collectibles such as antiques, fine art, stamps, coins, or baseball cards?
Yes
No
2) Do you own valuable jewelry or furs?
Yes
No
3) Do you own costly sporting equipment or firearms?
Yes
No
4) Do you have valuable cameras or other photography equipment?
Yes
No
5) Do you have any alarms installed in your home?
Yes
No
Type of Alarm:
6) Do you keep more than $100 cash in your home?
Yes
No
7) Are your personal belongings insured for their full replacement value?
Yes
No
8) Do you have children away at college?
Yes
No
9) Do you own tools, equipment, or instruments used in your trade or profession?
Yes
No
10) Do you operate an office or studio in your home?
Yes
No
11) Do clients come into your home to make purchases?
Yes
No
12) Do you baby-sit in your home?
Yes
No
13a) Have you recently remodeled or redecorated your home?
Yes
No
13b) Do you have plans to remodel or redecorate in the future?
Yes
No
14) If your home suffered an entire loss, would your insurance cover your home's full replacement value?
Yes
No
15) Are you interested in flood insurance for your home and personal property?
Yes
No
16) Are you interested in earthquake coverage?
Yes
No
17) Do you have a wood burning stove?
Yes
No
18) Do you have a swimming pool?
Yes
No
19) Do you own rental or investment property?
Yes
No
20) Do you own a vacation home?
Yes
No
21) If you rent, do you carry renter's insurance?
Yes
No
22) Do you plan to purchase a new vehicle this year?
Yes
No
Would you like us to provide you with an insurance estimate on the vehicle(s) you are considering?
Yes
No
List the type of vehicle(s):
23) Does our agency insure all of your vehicles?
Yes
No
24) Does your automobile policy specify by name all of the drivers in your household?
Yes
No
25) Do you routinely use vehicles you do not own?
Yes
No
26) Do you have non-factory installed equipment, such as car phones, stereos, or CD players in your automobiles?
Yes
No
27) Do you store CD's or cassette tapes in your car?
Yes
No
28) Do you own a vehicle with custom furnishings or equipment?
Yes
No
29) If your vehicle were in an accident, would your current automobile insurance reimburse you for a rental vehicle while yours is being repaired?
Yes
No
30) Do you own any of the following?
Camper
Moped
Golf Cart
RV/Motor Home
All-Terrain Vehicle
Boat or Personal Watercraft
Other
Describe Other:
31) Do you carry at least a one-million-dollar umbrella liability policy?
Yes
No
32) Do you own a business?
Yes
No
Do we currently insure it?
Yes
No
33) Do you plan to start a business?
Yes
No
34) Would you like a no-obligation review of your life insurance needs for your business?
Yes
No
35) Do you have sufficient liability or malpractice coverage?
Yes
No
36) Do you and your family have proper health insurance coverage?
Yes
No
37) Do you have disability income insurance?
Yes
No
38) Do other family members need such coverage?
Yes
No
39) Do you have life insurance which pays your mortgage in case of your death?
Yes
No
40) Are you insured for long-term supervised health care?
Yes
No
41) Do you know anyone else who could benefit from a no obligation insurance review from our agency?
Yes
No
Name
First
Last
Phone
Name
This field is for validation purposes and should be left unchanged.
Δ
