Personal Renewal Review Your Name* First Last Your Email* Your Phone*Your Auto Insurance Company* Your Home Insurance Company* Auto Renewal Date* MM slash DD slash YYYY Home Renewal Date* MM slash DD slash YYYY Has anyone moved into your residence since your last policy renewal who is a licensed automobile operator?* Yes No Their Name, DOB, and License Number*NameDOBLicense #Car Driven Has anyone moved out of your residence since your last policy renewal who is a licensed automobile operator?* Yes No Their Name, DOB, and License Number*NameDOBLicense #Car Driven General Life Changes that may impact insurance (check all that may apply to you or members of your household) Had a baby Got married or engaged Got separated or divorced Purchased secondary or investment property Someone moved in or out of your household (including child) Homeowners Insurance Discounts (check all that may apply to you) Fire or Burglar alarm installed (monitored by company such as ADT, Brinks, etc.) Gas alarm installed (such as carbon monoxide alarm or automatic gas main shut-off) Water alarm Non-smoker Life Changes that impact Home Insurance (check all that may apply to you) Completed a home remodel, improvement, or addition Purchased or inherited high value items like jewelry, firearms, or artwork Purchased an outdoor trampoline Began renting out your home, either on a long-term or short-term basis (like Airbnb) Started a home-based business or have a hobby that earns income Have a new dog Please check any items that are in/on your property in the last 12 months Dog Trampoline Swimming Pool Other None of the above Auto Insurance Discounts (check those that may apply to you or members of your household) Driver Safety Course Completion (age 55+) AAA Member Good Student (3.0 GPA or higher) Child away at college (75+ miles away or more) without car Low Mileage Driver (8,000 miles per year or less) Life Changes that impact Auto Insurance (check those that may apply to you or members of your household) Recently paid off a loan or lease for one of your cars Have (or will have) a teen driver Changed jobs or retired Drive for work, such as Real Estate Agent, Uber, or Pizza Delivery Please tell us about any other changes in your household since last policy renewal if any, or any other applicable notes that may help us determine the proper limits of coverage for your auto and/or home insurance policies
