Automobile / Vehicle Information Have you considered increasing your deductible to lower your premiums? Yes No Do we presently insure all of the vehicles in your household? Yes No Are all licensed drivers in your houshold listed on your auto policy? Yes No If you own a pickup or a van, does it contain any customized equipment? Yes No Do you own any camping or recreational vehicles (including a golf cart)? Yes No Do you want rental car coverage in the event your car is damaged in an accident? Yes No Would you like to review the current limits and other coverages on your vehicles to see if they are still suited to your needs? Yes No Homeowners / Renters Information Do you own any antiques, fine art or paintings? Yes No Do you own any collections such as unique dishes, Indian artifacts, stamps, coins. etc.? Yes No Do you own any jewelry, furs or silverware valued over $1,500? Yes No Do you frequently keep money over $100 in your home? Yes No Do you own any guns? Yes No Would you like replacement cost contents coverage added to your renewal policy? Yes No Do you have a wood stove in your home? Yes No Do you presently have either a burglar, fire or smoke alarm system in your home? Yes No Have you remodeled your home recently? Doy you plan to in the near future? Yes No Do you own a second home or any other real property, such as a cabin, lake house or farm property? Yes No Do you conduct any business or give private lessons in your home? Yes No Do you own any rental or investment propert? Yes No Would you be interested in an Excess Umbrella (Liability) policy which extends your auto and homeowners liability coverage to $1,000,000 or more? Yes No Do you plan to buy a new home or mobile home this coming year? Yes No Would you like us to send a form to assist you in making an inventory of your personal property? Yes No Other Personal Insurance Information Do you have disability income insurance in case you are disabled? Yes No Do you have a boat? Yes No If you have a boat, what is the horsepower? If you have a boat, what is the size or length? If you have a boat, where is it used? Are all members of your family protected by life insurance? Yes No Are you interested in discussing life insurance within the next year? Yes No Would you like a review of your life insurance beneficiary and ownership arrangements? Yes No Is your health insurance sufficent, considering the medical inflation rate? Yes No Do you plan to start a new business in the near future? Yes No   Your Contact Information First and Last Name: * Address: State: Zip Code: Phone Number: * Email Address: * This fact finder serves to help identify your financial needs and priorities and may be used in developing proposed solutions consistent with your needs and objectives. In completing this fact finder, you are entrusting our organization with certain personal and confidential financial data. We recognize that our relationship with you is based on trust and we hold ourselves to the highest standards in the safekeeping and use of your confidential information.