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Account Review Form

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Do you own collectibles such as antiques, fine art, stamps, coins, or baseball cards ... valuable jewelry or furs .. costly sporting equipment or firearms ... expensive cameras or other photography equipment?*
- Yes
- No
Do you have any burglar or fire alarms installed in your home?*
- Yes
- No
Do you have a standby generator, home temperture monitor, or sump-pump backup battery?*
- Yes
- No
Do you have children away at college?*
- Yes
- No
Do you own tools, equipment, or instruments used in your trade or profession?*
- Yes
- No
Do you operate a business in your home?*
- Yes
- No
Are you concerned about water backup through sewers or drains, or the failure of mechanical systems like central air conditioning or underground utility services?*
- Yes
- No
Do you or your resident children baby-sit for a fee?*
- Yes
- No
Have you recently remodeled your home or have plans to do so?*
- Yes
- No
Would you like us to re-evaluate the estimated cost to rebuild your home?*
- Yes
- No
Are you interested in Flood Insurance for your home and personal property?*
- Yes
- No
Are you interested in Earthquake Coverage?*
- Yes
- No
Are you interested in learning about coverage for Residential Fuel Tank leakage?*
- Yes
- No
Are any animals or pets kept on your property?*
- Yes
- No
Do you use a wood, coal, or pellet-burning stove?*
- Yes
- No
Do you have a swimming pool?*
- Yes
- No
Do you own rental or investment property?*
- Yes
- No
Do you rent any part of your home for any part of the year (not including rental apartments in your multi-family home)?*
- Yes
- No
Do you own a vacation residence (e.g., condo, cabin, or trailer)?*
- Yes
- No
Does our agency insure all your vehicles?*
- Yes
- No
Does your automobile policy list the names of all drivers living in your household?*
- Yes
- No
Do you routinely drive vehicles you do not own (such as, a company vehicle)?*
- Yes
- No
Do you own a vehicle with custom furnishings or equipment (i.e., not factory installed, such as a conversion van)?*
- Yes
- No
Is your vehicle used in a ride-sharing (such as Uber or Lyft)?*
- Yes
- No
If your vehicle were damaged in an accident, would you need your current Automobile Policy to reimburse you for a rental car while yours is being repaired?*
- Yes
- No
Do you own any recreational vehicles?*
- Yes
- No
Would you like to review your liability risks and how well protected you are if someone sued you?*
- Yes
- No
Do you own a business?*
- Yes
- No
Do you have Disability Income Insurance?*
- Yes
- No
Would you like a no-obligation review of your personal Life Insurance needs?*
- Yes
- No
Do you have Long-Term Care coverage to protect your savings from expensive nursing home costs?*
- Yes
- No
Do you know anyone else who might benefit from a no-obligation insurance review from our agency?*
- Yes
- No
Would you like to communicate with us by text messaging?*
- Yes
- No
Comments
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(508) 996-8593

Fax: 508-990-1784

Hours: Mon-Fri
9:00 AM - 5:00 PM

Joseph Arthur Beauvais House
404 County St.
New Bedford, MA

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Request Account Review
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