Want A Review?

General Information

Your First And Last Name

Your Spouse's First And Last Name

Your eMail Address

Best Day(s) of the Week to meet?

Best Time(s) of the Day to meet?

How Has Your Life Changed?

Marriages

Births

Is The age of your oldest child 6 Years or below? Enter your OLDEST child's name and date of birth

New Drivers

Children Going To College

New Business Start-Up

Deaths

Divorces

Retirements

Change In Employment

Change In Employment Benefits

Change In Health

New Contact Information - Please enter below any new email addresses, cell phone numbers, telephone numbers, mailing addresses, etc.

Do you or your spouse have a degree, or are you occupied in any of the following professions? Doctor, Nurse, Law Enforcement, Engineering (including computers) Scientist, Fire Fighting, Educator, Military, Veterinarian, Dentist, Accountant?

Enter Any General Comments below based on the previous questions or specific issues you would like to discuss in the review concerning changes to your current cirmcumstances:

Protecting Your Home...

Would you be interested in a proposal for FLOOD or EARTHQUAKE insurance?

Do you own jewelry, watches, guns, or furs that exceed $1,000 in value on any one item?

Does your total computer equipment exceed $5,000 in value?

Do you operate a business from your home?

Do you store a boat, recreational vehicles, such as motorbikes, motorcycles, snowmobiles, ATVs, at your home?

Do you have a central Burglar and Fire alarm installed and working in your home? If so, what company monitors the system?

Has your basement been recently finished or have you completed any major remodeling?

Do you own any rental property, mountain cabins, vacation homes, or vacant land?

If your plumbing, heating, electrical system or other appliances need to be repaired or replaced, would you want that covered?

Have you completed an itemized Personal Property Inventory which includes your furniture, clothes, and all of your belongings?

Have you taken digital pictures, or video taped your home and personal property? Remember to store them offsite.

Would you be interested in having an interior inspection on your home if it saved you money on your current premium?

Enter any Homeowners or Renters Comments below based on the previous questions or any specific issues you would like to discuss during our reivew:

Protecting Your Vehicles...

Have you recently purchased or sold any new vehicles?

Do you have any vehicles, motorcycles, boats, trailers, jet skis, ATV's, campers, snow mobiles or recreational vehicles which are not insured through our agency? List below in comments.

Enter Your Work Address

Enter Your Spouse Work Address

Are you "upside down" on a lease or loan? Do you currently owe a larger balance that the vehicle may be worth?

Has your vehicle been altered? (i.e., custom wheels, paint, or high performance, or added some stereo/TV/VCR/DVD equipment)

Do you keep over 15 tapes, CDs, or DVDs, or personal property valued over $200 in your vehicle?

Are you interested in adding our medical payment coverage to your auto policies which will cover you in case you are injured in an automobile accident.

Do you have any children who may become licensed drivers within the next year or two? We can give you several ideas to reduce the cost of their insurance.

Enter any Auto Insurance Comments below based on the previous questions or any specific issues you would like to discuss during our reivew:

Protecting Your Family...

What is your estimated total assets (home, savings, investments)

What is your estimated total liabilities (mortgage, loans, credit cards)?

What is your estimated total household annual income?

What is the TOTAL amount of life insurance you carrry?

	You	Spouse
With Farmers
Through Your Work
Through Another Insurance Company

Do you have health insurance?

Enter any Life & Health Insurance Comments below based on the previous questions or any specific issues you would like to discuss during our reivew:

Protecting Your Future...

Do you have developed a Retirement Plan for either you or your spouse?

Do you have an Traditional (IRA) Individual Retirement Account?

Do you have an Roth (IRA) Individual Retirement Account?

Do you have an Old 401K from previous employer?

Do you currently have some other form of retirement account such as a 403B, SEP? Please indicate below

Do you currently participate in a employer sponsored 401K or Pension Plan at work?

Do you have a long-term care insurance?

Do you have short term disability insurance?

Do you have long term disability insurance?

Have you prepared a will or trust?

Enter any Retirement or Asset Protection Comments below based on the previous questions or any specific issues you would like to discuss during our reivew: