Personal Renewal Questionnaire "*" indicates required fields Primary Insurance Contact* First Last Mobile Phone:*Text Messages*Please let us know if you approve contact via text messageYes - ApprovedNo - Do Not TextEmail Address*Please Provide Us With Your Best and Preferred Email Address Preferred Method of Contact*TextPhoneEmailHas your mailing address changed in the last 12 months?* Yes No Address* Street Address City State 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 ZIP Code Select policies that are renewing in the next 60 days?* Personal Auto Homeowners Personal Umbrella Watercraft Recreational Vehicle / Travel Trailer / Motorcycle / ATV / UTV Personal AutoHas there been a change in the number of drivers living in the household?* Yes No Describe ChangePlease provide name, DL# and birthdate if available. Have you bought or sold any vehicles in the last 12 months?* Yes No Describe ChangeProvide details of change with Vin# and requested coverageAre any vehicles on the policy used for transportation for hire, such as Uber or Lyft?* Yes No Which VehicleDo you have any additional questions, concerns, or feedback regarding your auto insurance policy?* Yes No Please Describe your Questions, Concerns, or Provide Any Feedback.*HomeownersHas there been a change with your mortgage?*Ex. New Mortgage/Paid off Home Yes No Provide details of changeHave you made any updates or improvements in the last 12 months?*Have there been any additions or updates to your home? Ex pool, solar panels, remodeling, additions, updates to the water, heating, plumbing, electrical or roof Yes No Please provide a brief description for all improvements*Home Sharing*Do you rent your home as part of a home-sharing or short term renting program like AirBnb, VRBO or other? Yes No Did you get a new pet?* Yes No What type of pet did you get? If a dog, please provide breed.Do you have any additional questions, concerns, or feedback regarding your home insurance policy?* Yes No Please Describe your Questions, Concerns, or Provide Any Feedback.*Umbrella PolicyAny significant changes in your assets or net worth that may require an adjustment in your personal umbrella policy coverage limits?*Ex. Inheritance of money or property Yes No Have you added or changed any recreational vehicles, boats, or other property to include houses that might warrant additional liability coverage under your personal umbrella policy?* Yes No Any changes in your household, such as new drivers, family members moving in or out that could affect your personal umbrella policy coverage?* Yes No Briefly describe changeWatercraft PolicyHave you made any modifications or purchased new equipment for your watercraft in the past year that may require an update to your policy?* Yes No Briefly describe changesHave you changed the way you use your watercraft?* Yes No What did you change?Have there been any changes to the storage location or have you transported your boat to a new location?* Yes No RV / Travel Trailer / Motorcycle / ATV / UTVHave you made any upgrades or purchased new accessories in the past year?* Yes No Briefly describe changesDo you rent any your toys to others? Yes No Finally...Do you have any insurance polices outside of Haven Insurance Partners?*For us to do a complete job in making sure you are protected, we need to be aware of any additional policies or assets you may have purchased to ensure there are no gaps in coverage. Yes No Policies outside of agency:* Auto Rental Property Personal Umbrella RV or Travel Trailer Homeowners Life / Mortgage Protection Watercraft Motorcycle or ATV Farm or Ranch Business/Commercial None at this time Personal AutoWho's your current auto carrier:*HomeownersWho's your current home insurance carrier:*RV / Travel TrailerWho's your current RV/Travel Trailer carrier:*WatercraftWho's your current watercraft carrier:*Motorcylce / ATV / UTVWho's your current Motorcycle / ATV / UTV carrier:*Business / CommercialWhat kind of business do you own?*Rental PropertyWho currently insures your rental property?*Personal UmbrellaWho is your umbrella carrier?*Life InsuranceIs it through your work?* Yes No Farm/RanchWho currently insures your farm?*Would you like a quote on any of the following?* Auto Homeowners Rental Property Personal Umbrella RV or Travel Trailer Life / Mortgage Protection Watercraft Motorcycle or ATV Farm or Ranch Business/Commercial None at this time Other OtherWe love feedback!!Do you have any feedback for us? Is there an area we can improve your experience?
