SPRINGTIME QUESTIONNAIRE
Check if yes:
Home
| YES | |
| Do you own your own home? |
| Do you rent? |
| Do you own any rental or investment property? |
| Would your current amount of coverage be enough to replace your home? |
| Would you like your coverage increased? If so, how much? ________ |
| Have you remodeled your home recently? |
| Do you plan to do it in the future? |
| Do you own any of the following: |
| Fine arts, antiques, or paintings? |
| Gems, watches, jewelry, furs in excess of $1,000? |
| Silver in excess of $2,500? Guns in excess of $2,000? |
| Personal property used in your profession which you keep on your premises? Valuable cameras and/or sporting equipment? |
| Watercraft? |
| Recreational vehicles, including electric or gasoline driven golf carts? |
| Do you keep over $200 at home or have a coin collection in excess of $200? |
| Do you or any members of your family own a business? |
| Is there any type of business or office on your premises? [Private lessons, music lessons, day care?] |
| Do you think your current liability limits and medical payments are adequate? |
Auto
| YES | |
| Does our agency insure all the auto needs in your family? |
| Do you have a vehicle, not your own, furnished for your use? |
| Would you like to review the current limits and coverages on your vehicle to see if they still suit your needs? |
Financial Planning
| YES | |
| Do you now have all of the Life Insurance you are ever going to buy? |
| If married, do your spouse and children own Life Insurance? (Can be designed to provide a means for funding education.) |
| Do you have insurance to continue your income if you are injured or disabled? |
| Do you have an IRA (Individual Retirement Account) providing flexibility of investment, comparative rate of return, tax savings, safety of principal? |
Would you like us to review your insurance program without any obligation? If so, please call us, or return this form.
Name ___________________________________________________________
Address __________________________________________________________
Home phone ______________________________________________________
Business phone ____________________________________________________
Best time to call ___________________________________________________
Remarks