Personal Lines Renewal Questionnaire

Renewal Questionnaire

The purpose of the renewal questionnaire is to maintain the most accurate details such as contact preferences and policy expectations. Please update any inaccurate prefilled details.

"*" indicates required fields

Today's Date*

MM slash DD slash YYYY

Name*

First Last

Please Enter the name listed first on your insurance policies

Email Address*

Please Provide Us With Your BEST AND PREFERRED Email Address

Mobile Phone:*

Text Messages*

Please let us know if you approve contact via text message

Preferred Method of Contact*

Are you married?*

Yes

What's your spouse's full name?*

Spouse's date of birth*

MM slash DD slash YYYY

What's your spouse's email?

What's your spouse's phone number?

Please confirm your address?*

Street Address City State / Province / Region ZIP / Postal Code

Simply to make sure we’re working on the right profile.

What insurance policies do you currently have with My Insurance Group?*

Personal Auto

Homeowners

Landlord

Flood

Renters

Stand Alone (Texas Windstorm)

Personal Umbrella

Watercraft

Recreational Vehicle / Travel Trailer

Motorcycle / ATV / UTV

Life Insurance

Personal Auto

Drivers*

Please List All Household Members Over The Age of 15 and provide Date of Birth. We will cross reference this list with the list we have on file to ensure accuracy.

How Many Vehicles Do You Currently Own?*

For the purpose of this review, we would like to know about your private passenger automobiles.

Vehicle 1*