PERSONAL INFORMATIONName(Required) First Last Phone(Required)Is It Ok To Communication Via Text From Time To Time(Required) Yes No Preferred Email Do You (Or Spouse When Applicable) Own A Business? No Yes CURRENT COVERAGE INFORMATIONPlease Select All Coverages You Currently Have With ALLCHOICE Homeowners Insurance Renters Insurance Auto Insurance Umbrella Insurance Flood Insurance Watercraft Or Boat Insurance Life Insurance Or Long Term Care Insurance Classic or Collector Car Insurance In The Past 12 Months…Have You Moved (Or Changed Mailing Address) No Yes What Is The Correct Address? Street Address City 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 State ZIP Code Have You Had Any Life Changes? No Yes New Child | Employment Change | Created A Living TrustTell Us About Your Life ChangesHas Your Marital Status Changed? No Yes Tell Us About Your Maritial Status ChangeHave You Made Any Additions? No Yes Additions would increase square footage?Have You Upgraded Or Replaced Any Of The Following? Roof Heating And Air Conditioning (HVAC) Plumbing Electrical Tell Us About Your UpgradesHave There Been In Changes To Your Mortgage(s)? No Yes Have You Purchased Any Jewelry Or Other Collectibles? No Yes Jewelry | Art | Sports Memorabilia | EtcWhat You Like A Quote For Flood Insurance No Yes Flood Is EXCLUDED on all home insurance policies. 25% of flood losses happen in low risk flood areas!Do You Operate A Home Based Business? No Yes Have You Purchased Any Motorized Equipment? No Yes Golf Carts | Tractors | 4 wheelers |Side By SIde | EtcHave You Added Or Removed Any Drivers? No Yes Tell Us About Your Driver ChangesHave You Added Or Removed Any Vehicles? No Yes Tell Us About Your Vehicle ChangesDo You Use Any Of Your Vehicles For Uber or Lyft or DoorDash Etc? No Yes Have You Paid Off Or Refinanced Any Vehicle Loans? No Yes Tell Us About Your Vehicle Loan ChangesWould You Like A Quote For An Umbrella Policy (Additional Personal Liability Coverage) Yes No – I don’t want to be fully protected 1.You Should Liability Protection Of At Least Your Gross Asset Value! 2. Gross Asset Value = Hard Assets + Earning Potential Until Retirement | Hard Assets = Home(s), Rental Property, Investment Accounts, Retirement Accounts | Earning Potential = Annual Income X Years Until Retirement Would You Like To Review Your Life Insurance? No Yes Are You Interested In An Affordable Life Insurance Quote? Yes No You Should Have At A Minimum 15 Years of your annual salary in Life Insurance Coverage OUTSIDE of your employer offered planAre There Any Other Items You Insure Elsewhere?(Required) No – ALLCHOICE Insures Everything I Have RV Boat And Or JetSki Motorcycle ATV Second Home Rental Property Please Let Us Know About Any Changes Or Updates Not Already Discussed Δ
