Your Annual Renewal Review - Bailey Family Insurance

Contact Information

Name:*

Prefix First Last

Email Address:

Home Phone:

Cell Phone:

Homeowners Information

Have there been any significant improvements to your home?*

If you answered yes, please briefly explain:

Have you purchased any jewelry, furs, art, cameras, musical instruments, or collectibles that need to be covered?*

If you answered yes, please briefly explain:

Have you purchased a secondary home, rental property, farm or vacant land?*

If you answered yes, please briefly explain:

Did you recently start an in-home business?*

If you answered yes, please briefly explain:

Have you had any change in marital status or are there any additional family members residing in your household?*

If you answered yes, please briefly explain:

Auto Information

Have you purchased any previously unreported vehicles?*

If you answered yes, please briefly explain:

Have you been given access to an employer provided vehicle?*

If you answered yes, please briefly explain:

Are there any new drivers in your household?*

If you answered yes, please briefly explain:

Has a child recently begun college?*

If you answered yes, please briefly explain:

Has a student driver recent qualified for a "good student discount" (3.0 grade point average or higher)?*

If you answered yes, please briefly explain:

General Information

Are you satisfied with your current insurance program?*

Are you interested in an 'in person' or over the phone review of your insurance (auto, home, renters, business, life, boat, disability income, long term care, etc.)?*

How can we better assist you in the future?

Any additional comments you would like to share:

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