JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Homeowners Renewal Questionnaire
Please fill out all of the information below to make sure there have been no changes and you are still insured correctly
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Have you made any upgrades to your home? (ex: plumbing, roof, heating, electric, etc.)
Yes
No
Clear selection
If yes please describe the update and list when the work was completed.
Your answer
Have you put an addition on your home, built any garage or other buildings?
Yes
No
Clear selection
If yes please describe.
Your answer
Do you feel the current limits are adequate to rebuild your home?
Yes
No
Clear selection
Are you comfortable with your current deductible?
Yes
No
Clear selection
If no, what deductible would you feel more comfortable with?
Your answer
Do you have a pool?
Yes
No
Clear selection
Do you have a finished basement?
Yes
No
Clear selection
Do you have a sump pump?
Yes
No
Clear selection
Do you own or have you purchased a secondary residence, seasonal, or rental property?
Yes
No
Clear selection
Is your home protected by a central station burglar alarm?
Yes
No
Clear selection
Is your home protected by any other devices? ( ex: cameras, smart sensors, automatic generator, etc.)
Yes
No
Clear selection
If yes please describe below
Your answer
Do you have an at home business?
Yes
No
Clear selection
If yes please describe below
Your answer
Do you have jewelry that needs to be scheduled? (most policies have a limit of only $300- $5000)
Yes
No
Clear selection
Flood/ Surface water is not covered on a homeowners policy would you like a quote?
Yes
No
Clear selection
Earthquake and Sink Hole is not automatically covered on a homeowners policy would you like a quote?
Yes
No
Clear selection
If your Auto insurance is not through us would you like a quote to see if we can get you any package discounts?
Yes
No
Clear selection
Do you own any Motorcycles, RVs, ATV or Boats?
Yes
No
Clear selection
If yes and you would like a quote please list the vehicles below.
Your answer
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Gansfuss Agency.
Report Abuse
Forms
