in Jackson, TN | Haven Insurance Partners

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Address: 101 N Highland Ave
Jackson, TN 38301
Phone: (731) 577-4300
Email: service@haveninsurance.com

Home
About Us
- Our Team
- Our Blog
Coverages
Contact Us
- Leave A Review
- Refer Friends & Family
Service My Account

Get Quotes Here

Renewal Questionnaire - Simple

This questionnaire is for clients that have Personal Insurance with us, such as home and auto insurance.

"*" indicates required fields

Primary Insurance Contact*

First Last

Mobile Phone:*

Text Messages*

Please let us know if you approve contact via text message

Email Address*

Please Provide Us With Your Best and Preferred Email Address

Preferred Method of Contact*

Has your mailing address changed in the last 12 months?*

Yes

No

Address*

Street Address City State 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 Auto

Has there been a change in the number of drivers living in the household?*

Yes

No

Describe Change

Please provide name, DL# and birthdate if available.

Have you bought or sold any vehicles in the last 12 months?*

Yes

No

Describe Change

Provide details of change with Vin# and requested coverage

Are any vehicles on the policy used for transportation for hire, such as Uber or Lyft?*

Yes

No

Which Vehicle

Do you have any additional questions, concerns, or feedback regarding your auto insurance policy?*

Yes

No

Please Describe your Questions, Concerns, or Provide Any Feedback.*

Homeowners

Has there been a change with your mortgage?*

Ex. New Mortgage/Paid off Home

Yes

No

Provide details of change

Have 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 Policy

Any 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 change

Watercraft Policy

Have 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 changes

Have 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 / UTV

Have you made any upgrades or purchased new accessories in the past year?*

Yes

No

Briefly describe changes

Do 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 Auto

Who's your current auto carrier:*

Homeowners

Who's your current home insurance carrier:*

RV / Travel Trailer

Who's your current RV/Travel Trailer carrier:*

Watercraft

Who's your current watercraft carrier:*

Motorcylce / ATV / UTV

Who's your current Motorcycle / ATV / UTV carrier:*

Business / Commercial

What kind of business do you own?*

Rental Property

Who currently insures your rental property?*

Personal Umbrella

Who is your umbrella carrier?*

Life Insurance

Is it through your work?*

Yes

No

Farm/Ranch

Who 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

Other

We love feedback!!

Do you have any feedback for us? Is there an area we can improve your experience?

Contact Info

Address: 101 N Highland Ave
Jackson, TN 38301
Phone: (731) 577-4300
Email: service@haveninsurance.com
Opening hours 9:00-4:30 M-F

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