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Text: 740-688-3050

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You Deserve an Attentive Agency.

Please take 5 minutes to share, confirm and update your information. This form helps us identify potential discounts and other coverage issues that should be discussed.

*If you choose not to complete the form we will assume there have been no changes.

Policy Renewal Review Form

First Name

Last Name

Email

Phone

Your Address

Which type of coverage are you updating?

Both Home and Auto

Auto Only

Home/Renters Only

Change of address recent or upcoming?

Yes

No

Change of marital status recent or upcoming?

Yes

No

Please list all household occupants of the age of 15 and over

Are There Any Autos Owned/Registered/Co-Titled To You That Are Not Listed On Your Policy?

Yes

No

Is There Anyone Not Listed On The Policy - Drivers, Household Residents 16 Or Older, Others - With Access To A Covered Auto For Regular Use?

Yes

No

Are All Vehicles Titled To You Or Your Spouse?

Yes

No

Any Vehicles Used For Business Purposes or Ride Sharing (Ex. DoorDash, Uber, Etc.)?

Yes

No

There Are Many Carrier Specific Coverages Available For Your Auto Policy. Some Examples Are: Rental Reimbursement, GAP, Roadside/Towing, $0 Glass Deductible, Accident Forgiveness, Disappearing Deductible, Customized Equipment, Etc.. If You Have Questions About Any Of These Coverages, Or Would Like Quotes, Please Let Us Know Below:

Increased Limits Of Liability May Be Available Upon Request. If You Are Interested, Please Let Us Know.

Yes

No

I have reviewed my auto policy, and would like to make changes. Please contact me.

Yes

No

Are The Location And Mailing Address On Your Policy Correct?

Yes

No

Home Is Deeded To You Or Your Spouse (Not A Trust, Estate, Or Other)?

Yes

No

If You Have A Mortgage, What Company Services It? *Please Notify Us Of Any Changes, ASAP, As This Can Impact Your Renewal Payment.

Is There Any Business Conducted Out Of The Home Or On The Premises?

Yes

No

Have You Recently Made Any Additions, Improvements, Or Other Updates To Your Home? Have You Notified Us Of A Recent Roof Replacement, Or Have You Added A Monitored Alarm System?

Yes

No

Do You Have Any Liability Hazards On Premises (Included But Not Limited To - Trampoline, Pool (Diving Board Or Slide), Supplemental Heat (Woodstove, Pellet Stove, Etc.), Animals, Farming, Other Business, Etc.)? Please Provide Details Below:

I Have Reviewed My Coverage Limits For My Home, Condo, Or Renters Policy. I Agree The Limits Listed Are Adequate To Replace My Home, Detached Structures, Or Personal Property, In The Event Of A Loss.

Yes

No

I Understand My Policy Has Limits On Certain Types Of Personal Property (Ex. Jewelry, Firearms, Cash, Etc). I Am Aware Of These Limitations And Have The Option To Purchase Additional Coverage, If Needed.

Yes

No

There Are Many Optional Coverages Available That Are Specific To Each Company. Example: Water And Sewer Back Up, Equipment Breakdown, Identity Theft, Ordinance Of Law, Earthquake, Etc. If You Are Interested, Or Would Like More Details On These Coverages, Please Let Us Know In The Box Below.

Are you interested in Life Insurance?

Yes

No

Maybe

Are you interested in Umbrella Insurance?

Yes

No

Maybe

Thanks for your submission, we'll reach out to you soon!

Business Insurance

Personal Insurance

Vacation Rental Insurance

Renewal Information

Stockton-Hill Insurance

10212 State Route 159

PO Box 648

Kingston, OH. 45644

P: 740-642-3333
T: 740-688-3050
E: inquire@stocktonhillinsurance.com

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Ohio, Arkansas, Kentucky, North Carolina, South Carolina, Florida, West Virginia, Texas, Tennessee, Indiana, and Georgia.

©2023 by Stockton-Hill Insurance.

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