PL Renewal Form Step 1 of 13 7% Name First Last Email Occupation(Required) Higher Education:(Required)Some CollegeAssociatesBachelorsGraduateNoneSpecify amount of hours earned to date:(Required) Are you driving for a rideshare or delivery company? Yes No If yes what company? Have you started using your vehicle for business? Yes No (Roofing, real estate, advertisement, etc.)What Business? Please check all situations that apply to you. Address Change Birth of a child Career Change Driver Added Driver Removed Home renovations/improvments Marital Status Purchased ATV/Motorcycle/Slingshot Purchased Boat Purchased Home/Rental Property/Second Home Started A Business Vehicle Bought Vehicle Sold No Changes Date You Moved MM slash DD slash YYYY Updated Address Street Address Address Line 2 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 Name Birthday Congrats on the new career! What is your new job title? Add Driver To Policy First Last Birthday Relationship to YouSpouseChildParentOtherDL # Remove Driver From Policy First Last What is your current marital status? Married Divorced Widowed Spouse Name What new toy(s) did you purchase? ATV Boat Golf Cart Motorcycle Slingshot List make, model and estimated purchase price for each new toy.YearMakeModel Add RemoveClick the + to add more rows. What type of property did you purchase? Primary Home Rental Home/Investment Property Second Home/Vacation Home Date Purchased MM slash DD slash YYYY New Property Address Street Address Address Line 2 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 Is the Property currently insured? With who? What is the name of your new business? What is the industry of your new business? Is your business currently insured? Yes No Date Purchased MM slash DD slash YYYY Year/Make/Model of purchased vehicle(s)YearMakeModel Add RemoveClick the + to add rows for additional vehicles.Date Sold MM slash DD slash YYYY Year/Make/Model of sold vehicle(s)YearMakeModel Add RemoveClick the + to add rows for additional vehicles. Please list the renovations and an approximate cost of each. Add RemoveYou can use the + button on the right side to add additional rows. Are there any additional changes that we should know about prior to your insurance renewal? Personal Insurance ReviewToday's Date MM slash DD slash YYYY Auto Insurance ProtectionLet’s say you were driving to work tomorrow, had an accident, you were at fault, and there was 300,000.00 in damages. Would you want your policy to pay all damages?YesIt’s not something I’m concerned aboutLet’s say you had a few glass claims (could be broken window or a wind shield that needs replaced), would you prefer to pay for that out-of-pocket or would you prefer for your insurance premiums to go up to cover that cost?Pay for them out of pocketRather pay higher premium and have itIf you had damage to your car, would you rather have a lower deductible for less out-of-pocket cost, or would prefer to lower your premiums by choosing a higher deductible?Lower deductible, higher premiumHigher deductible, lower premiumHow many licensed drivers are in your household? Home Insurance ProtectionDo you have an insurance policy that covers your outstanding mortgage:YesNoDo you have any jewelry you would want replaced if it were lost on vacation?YesNoHave you made any improvements or additions to your home over the past couple of years? ex: plumbing, electrical, roof, HVAC, etc.YesNoIf you HAVE made any improvements or additions to your home over the past couple of years, please describe below: If you had a sewer backup and your carpet or flooring was ruined, would you want it replaced by your policy?YesNoHave you added a burglar alarm or other security device since your last policy renewal?YesNoIf you DO have a burglar alarm or other security device, please describe below: Let’s say you were involved in an accident in your car, or someone hurt themselves on your property, and you were sued for $1,000,000. Where would you want the money to come from?My insurance policyIt’s not something I’m concerned aboutI don’t knowGeneral QuestionsDo you have any income producing hobbies?YesNoDetails if YES, you do have any income producing hobbies: Do you have any collections, such as guns, art, or jewelry?YesNoDetails if YES, you do have any collections: Do you have any vacation homes or rental properties?YesNoDetails if YES, you have any vacation homes or rental properties: Do you have an inventory of all your household possessions in photo/video form, or an itemized list?YesNoIf YES, how do you have the inventory saved and/or would you like us to help you make sure this list has everything listed that is needed: Have you made any major purchases during the past year?YesNoDetails if YES, you have made any major purchases during the past year: Have there been any major family dynamic changes during the past year (examples: marriage, birth, deaths, adoptions, etc.)?YesNoDetails if YES, you have had major family dynamic changes during the past year: Recreational Vehicle ProtectionDo you have any vehicles such as boats, motorcycles, ATV’s that you would want coverage on?YesNoDetails if YES, you do have any vehicles such as boats, motorcycles, ATV’s that you would want coverage on: Life InsuranceIf you were to pass away, would you want there to be a check for your family to help pay the bills?YesNoDo you currently have a life insurance policy outside of your employer?YesNoImportant Little DetailsWould you be interested in purchasing additional life insurance on top of what you currently have in place?YesNoWhat policies do you currently have in place that are NOT with Lennox Insurance? All of my policies are with Lennox Insurance Auto Homeowners Umbrella Recreational Vehicles Life Business Would you like us to quote your insurance on the policies that you do NOT currently have with Lennox Insurance?YesNoServiceHas anyone in our office provided exceptional service at any time? Are you satisfied with your insurance program with our agency? Can you think of any friends, relatives, or neighbors that we can help with their insurance needs? Would you like information on our referral programs?YesNoIf you are not satisfied with your insurance program with our agency, please tell us why: If we have any questions arise before your review meeting, what is the best phone number and time to reach you? Preferred method of contactPhone callEmailTextOur renewal specialist, Ashton Hunt, would love to schedule an appointment with you to go over your insurance policy renewal. Please follow the link or call our office at 870-236-3200 to schedule an appointment with her. If using the link, please note whether you would like your appointment to be in-person or via phone call. PhoneThis field is for validation purposes and should be left unchanged.
