Renewal - Homeowners - RiskRevu.com

What is your first name? **

What is your first name? *

What is your last name? **

What is your last name? *

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Name

What is your full name?

What is your preferred phone number? **

What is your preferred phone number? *

What is your email address? **

What is your email address? *

Enter the street address for the home we are discussing. **

Enter the street address for the home we are discussing. *

Did you install an alarm system in your home in the last 12 months?

Yes
No

Which components are included in your alarm system?

Fire/Smoke
Burglar/Motion
Low Temperature
Water Leak Detection
Cellular Backup
Explosive Gas Leak Detection
Other

What other alarm components does your alarm system have?

What risk management strategies do you employ at this residence?

Enter a brief description of the risk management strategy you have at your home.

Is your home owned by a trust, LLC or other legal entity?

Yes
No

Please provide the name of the trust, LLC or other legal entity your home is owned by.

Any updates/renovations/additions planned or recently completed?

Yes
No

Please tell us about the renovations.

Have you updated any of these?

Electrical
Plumbing
Heating
Windows and/or doors
Roof
No updates
Other

Please enter a brief description of any other updates you have done to your home. **

Please enter a brief description of any other updates you have done to your home. *

What other areas should we discuss?

Building a house
Buying/Selling property
Change of marital status
Child going to college
Property held for rental
Starting a business
Planning a big trip
None
Other

Please enter a brief description of the other area we should discuss. **

Please enter a brief description of the other area we should discuss. *

Does this home include solar panels? **

Does this home include solar panels? *

Yes
No

Solar Panel Information

How is the power generated by the solar panels being used? (Check all that apply)

Home Power Generation
Pool Heating
Other

How many solar panels are there?

Where are the solar panels located? (Check all that apply)

Roof of the Main Dwelling
Roof of a Secondary Structure
Ground Mounted
Other

Do you own or lease the solar panels?

Own
Lease

Are you responsible for insuring the panels?

Yes
No

What is the value of the solar panels? **

What is the value of the solar panels? *

Do you operate a business out of your home?

Yes
No

Please tell us about your in-home business.

Any significant acquisitions in the past 12 months that we should know about?

Jewelry
Fine Art
Silverware
Wine
Antiques
Firearms
Collectibles
Other

What other valuable acquisitions should we know about?

Do you have any new appraisals for your valuables that you can upload to us?

Yes
No

Feel free to upload your appraisals to us.

Drop files here or

Max. file size: 128 MB.

Has the occupancy status of your home changed?

Yes
No

How has the occupancy of your home changed?

Renting to a long term tenant
Renting to a short term tenant (by the day, week or month)
Unoccupied for greater than 30 days
Unoccupied and for sale
Other

What is the occupancy of this location?

Did you hire any domestic staff?

Yes
No

Please provide of description of the employee duties and the number of hours worked on a weekly basis.

Would you like to discuss obtaining new flood coverage or higher flood coverage limits for your home?

Yes
No

Anything else you want to discuss regarding your homeowners insurance?

Consent*

Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.

I agree *

Homeowners Evaluation

Solar Panel Information

Agent Name

RiskRevu^TM Newsletter

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Homeowners Evaluation

Solar Panel Information

Agent Name

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RiskRevuTM Newsletter

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RiskRevu^TM Newsletter