Personal Lines Renewal Form Personal Lines Intake Form Personal Lines Intake Form Step 1 of 14 7% Name(Required) First Last Email(Required) Which policies are renewing for you?(Required) Homeowners Auto Investment Property Other Please check all situations that apply to you.(Required) Address Change Birth of a child Career Change Driver Added Driver Removed Home renovations/improvements Marital Status Purchased ATV/Motorcycle/Slingshot Purchased Boat Purchased Home/Rental Property/Second Home Roof Replacement Started A Business Vehicle Bought Vehicle Sold No Changes Home QuestionsDo you have a pool?(Required)Yes - IngroundYes - Above GroundNoIs your pool fenced?(Required)YesNoDoes your pool have a diving board or slide?(Required)Yes - Diving BoardYes - SlideNoDo you have a trampoline?(Required)YesNoDoes your trampoline have a safety net?(Required)YesNoIs your backyard fenced and locked?(Required)YesNoDo you own an animal with a bite history?(Required)YesNoDo you have any jewelry needing insured?(Required)YesNoList(Required)DescriptionValuePurchase Date Add RemoveWhen was your roof last replaced?When was your furnace last replaced?When was your A/C last replaced?Do you have a wood burning stove?(Required)YesNoDo you have hail resistant shingles?(Required)YesNo Auto QuestionsAre you driving for a rideshare or delivery company?(Required) Yes No If yes what company?(Required)Have you started using your vehicle for business? Yes No (Roofing, real estate, advertisement, etc.)What Business?Are you interested in a connected driving app if available with your auto insurance company for a discount?(Required) Yes No Update AddressDate You Moved MM slash DD slash YYYY Updated Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code NameBirthday Congrats on the new career! What is your new job title?(Required) Add Driver To Policy First Last BirthdayRelationship to YouSpouseChildParentOtherDL #(Required)Remove Driver From Policy First Last What is your current marital status? Married Divorced Widowed Spouse Name What new toy(s) did you purchase? ATV Boat Golf Cart Motorcycle Slingshot List make, model and estimated purchase price for each new toy.YearMakeModel Add RemoveClick the + to add more rows. What type of property did you purchase?(Required) Primary Home Rental Home/Investment Property Second Home/Vacation Home Date Purchased MM slash DD slash YYYY New Property Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is the Property currently insured? With who? What is the name of your new business?What is the industry of your new business?Is your business currently insured? Yes No Date Purchased MM slash DD slash YYYY Year/Make/Model of purchased vehicle(s)YearMakeModel Add RemoveClick the + to add rows for additional vehicles.Date Sold MM slash DD slash YYYY Year/Make/Model of sold vehicle(s)YearMakeModel Add RemoveClick the + to add rows for additional vehicles. Please list the renovations and an approximate cost of each. Add RemoveYou can use the + button on the right side to add additional rows.Are they UL4 rated/hail proof?YesNo Are there any additional changes that we should know about prior to your insurance renewal?CAPTCHANameThis field is for validation purposes and should be left unchanged.
