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Renewal Survey-Karen Ehlers Insurance Agency


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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E-Mail Address
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Best Way to Contact
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Phone Numbers
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Would you like a client portal to have 24 hour access to your policies?
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Have you made or plan to make any changes to your home?
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When was roof replaced last?
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Any Collections Valued over $500?
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Do you have any ATV's, Golf Carts, Boats, Jet Ski's, Classic Cars, Travel Trailers, or Motorhomes?
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Who is current employer and occupation?
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Do you have adequate life insurance outside of employer?
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Do you own your own business?
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Do you have any other policies with any other carriers/agents?
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If you were sued from an accident or homeowners claim, do you feel you have enough liability coverage in the event a judgement against you?
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Any other policies with other carriers?
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Do you have a monitored burglar/fire alarm?
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Any new household members?
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Any customization on Vehicles?
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Any vehicle used for Uber, Lyft, Delivery, or any business purposes?
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Any additional comments?
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.