Annual Insurance Review

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Auto / Car Insurance Review

If applicable, do any of your licensed children qualify for the good student discount for grades of at least a 'B' or above? Yes No N/A

Have you purchased/sold a vehicle lately that needs to be added or removed from your policy? Yes No N/A

Are all of your vehicles insured through Axcess Insurance Group? Yes No N/A

Do you have another car to use in the event your car needs to be repaired because of a claim? Yes No N/A

Have you added any equipment to your vehicle other than the manufacturer-installed items? Yes No N/A

Have you recently purchased any of the following miscellaneous vehicles? (Please check all that apply) Motorcycle ATV Vintage/Classic Car Golf Cart Motor Home Trailer Snowmobile Camper

Homeowners Insurance

Are there any new additions, remodeling projects, or updates to your home? (i.e. new roofing or siding) Yes No N/A

Are there any valuables in your basement potentially exposed to water damage? Yes No N/A

Are there any types of business being conducted from your home? Yes No N/A

Have you recently purchased any of the following? (Please check all that apply) Computers Jewelry Firearms Condo Collectibles Boat Fine Art Rental Property Second home or Vacation property Additional structures on property

Additional Information

(Optional) Are you interested in...

...coverage that protects you against identity theft? Yes No N/A

...an umbrella policy that can protect your family and assets against large personal liability lawsuits? Yes No N/A

...reviewing life insurance policies? Yes No N/A

...an annuity savings plan, such as IRA or Roth? Yes No N/A

...exploring options to change your deductible and possibly save money? Yes No N/A

...a hassle-free electronic payment option for your insurance bill? Yes No N/A

We appreciate your feedback!

How satisfied are you working with Axcess Insurance Group?

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