Do you own collectibles; antiques, fine art, stamps, coins, etc.? 

Do you own costly sporting equipment or firearms?

Do you own valuable jewelry or furs or have you recently purchased new items?

Do you own photography equipment or musical instruments? 

Value?

Do you own your own business, have an office in your home and/or do clients or customers come to your home?

Do you own a computer (including laptop)?     
Description/Value? 

Do you keep samples/items for sale in your home (i.e. Avon, Mary Kay, Home Interior etc)

Do you baby-sit or have child day care in your home?

Do you own rental or income property?

Have you installed home alarms (i.e. smoke detectors, central alarm system)?

Do you keep more than $250 cash in your home?

Do you own recreational vehicles: boats, jet-ski, camper, cycle, etc.?

Have you remodeled your home?      Have plans to do so?  Yes No

Do you own a secondary residence or cabin?

Any “detached” buildings or structures?     
Type & Value:  

Do you have a swimming pool?    Trampoline?       Is your yard fenced?

Do you have a satellite dish?

Do you have any pets or exotic animals? 
If so what type/breed: 

Do you have roomers or boarders?

Do you have domestic help?   Babysitters?  Landscapers?  Cleaning?

Do you travel frequently?       Domestic? Foreign?

Do you have a wood-burning stove?      
Describe: 

Is your home in an area prone to flooding?

Are you interested in earthquake insurance?

If you rent, do you have insurance on your household possessions?

Any property stored at other locations?       
Where/Value: 

Does your homeowners policy provide “Back-up of Sewer/Drain Coverage”?

Have you reviewed your life insurance in the past 2 years?

Are all members of your family protected by life insurance?

Do you have health insurance?

Have we discussed with you the need for higher Home/Auto Liability Limits or Deductibles?

When was the last time you refinanced your mortgage?
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Do you use your car in business?

Do you carry tools and/or samples in your car that are used for business?

Do you drive out of the country; Canada or Mexico?

Does our agency insure all of your vehicles?

Does your automobile policy specify by name all the drivers in your household?

Do you have factory &/or non-factory installed equipment (alarms, stereos) in your automobiles?

Any classic or antique autos?         

Type/Value: 

Should you have towing, rental or other coverage?

Are you interested in home/auto discounts?

Are you interested in learning more about “umbrella” liability coverage? 

Time you would prefer contact:
Day: (empty) Monday Tuesday Wednesday Thursday Friday   Time:  (empty) Morning Afternoon

Phone Numbers in which we can reach you.

Day         Evening 

Name of person completing risk survey: 
Email address: