Renewal: Home Questionnaire - Inside Insurance

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Renewal: Home QuestionnaireMatthias Allred2025-03-06T10:45:10-07:00

Home Insurance Renewal Update

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Home Details

Condition of Roof*

Excellent

Good

Fair

Poor

How old is the Roof?*

Are there any Trees overhanging/touching the roof or vegetation growing on the house?*

No

Yes

If there are trees or vegetation overhanging the roof or touching the house, you will need to have them trimmed back.

Is there any peeling paint on the home/fascia/gutters, etc?*

No

Yes

Please provide details*

Peeling paint will need to be repaired.

Is there any debris or clutter in the yard?*

No

Yes

Please provide details*

Debris or clutter will need to be cleaned up or removed from property.

Do you have any dogs?*

No

Yes

Breed & Size*

Any history of dog bites?*

No

Yes

Provide Details of Bite History*

Do you have any scheduled items? (Jewelry, firearms, collectibles, etc.)*

No

Yes

Provide Details and Description*

Do you have a Trampoline?*

No

Yes

Is the Trampoline Above Ground? (not burried)*

Yes, above ground

No, it is buried (ground level)

Is there a net around the Trampoline?*

Yes

No

Contact Info

First Name*

Last Name*

Cell Phone*

Email*

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Admin Use Only

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Form Category

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Form Name

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Agency Name

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AMS ID

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CRM ID

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Internal Use

Yes

Internal Use

Person completing this form*

Matthias

Todd

Laura

Jenniea

Method request was received*

Phone Call

Email

Text Message

Chat / Messenger

Ezlynx Notification

Facebook

Agent Generated

Other

Agent Email

Additional Notes / Instructions

Task Due Date

MM slash DD slash YYYY

Task Assignee

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Task Assignee Full Name

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Task Assignee AMS User ID

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Task Assignee Email

The insured is responsible for reviewing and confirming all insurance coverages, terms, and conditions.
While we strive to provide accurate and up-to-date information, coverage details, limits, and exclusions are subject to the terms and conditions of the issued policy.
It is the insured’s responsibility to verify that their policy meets their specific needs. Please consult your policy documents and speak with your insurance provider or broker for any clarifications.

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