General/Misc Insurance Checkup Form

Please fill in your details below:

Please Check YES or NO and provide brief explanation if necessary:

1. Are you, your spouse, family trusts, LLCs, or similar interests specifically and consistently co-named on your insurance policies?

2. Are you interested in a flood insurance quote?

3. Are you interested in an earthquake insurance quote?

4. Would you like information on protecting your net worth with umbrella liability insurance

5. Do you own a second home, rental/investment property, vacant land or farming property?

6. Do you own watercraft?

7. Do you or does anyone in your family have a pilot’s license or do you own, rent, charter or lease aircraft?

8. Do you own recreational vehicles (jetski, golf cart, snowmobile, dirt bike, etc)

9. Do you own a business?

10. Are you interested in information or quote for life insurance?

11. Are you interested in information or quote for disability insurance?

12. Are you interested in information of quote for Long Term Care insurance?

14. How likely is it that you will recommend The Howes Insurance Group to your family and friends?

(Please rate from 1-10 with 1 the least likely and 10 being the most likely).