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On this page, you will find our Homeowners Survey. Completion of this survey allows our agency staff to ensure that your homeowner policy covers potential losses or to make recommendations for proper coverage. Thank you for your response.

Homeowners Survey
(Required fields are bold)

First Name
Last Name
Address (continued)
E-mail Address
Have you made any recent additions, remodeling or added any new exterior structures such as gazebo or swimming pool that would have increased the value of your home?
Yes   No
Is any property held in a trust?
Yes    No
Are you a member of a homeowner or condominium owner association?
Yes    No
The standard homeowner policy identifies specific dollar limits for some personal property lost as a result of theft. Other items have specific limits regardless of the cause of loss. These items include jewelry, furs, firearms, watercraft, antiques, and silverware to name a few. Do you have any items that might be more appropriately insured by scheduling them on your policy?
Yes    No
Do you use independent contractors (businesses) for landscaping or lawn mowing, housekeeping, etc.?
Yes    No
Do you own other properties such as rental properties, vacant land or farmland?
Yes    No
Do you perform incidental duties for any organization (school, religious, charitable) or serve as a member of board for any organizations?
Yes    No
Do you participate in any business from your home, or have any hobbies become “money-making” activities? Some examples include: crafts, sewing/alterations, income tax preparation, tutoring, Pampered Chef or similar home ware product sales.
Yes    No
Do you keep “business” property at your premises?
Yes    No
Any relative(s) now residing in a long-term rehabilitation or nursing facility?
Yes    No
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