Ramsburg Family Insurance Review Homeowners only

First Name *

Last Name *

Social Security Number

E-Mail Address *

Home Phone Number

Work Number

Cell Phone Number

Occupation

Highest Level of Education

Spouse Name

E-Mail Address *

Work Number

Cell Phone Number

Occupation

Preferred method of contact

Home Phone
Work Phone
Cell Phone
Email Phone

Homeowners Coverage

Please Enter Yes or No for the following Questions

Have you or are you planning on investing $15,000 or more in renovating your home? (Interior or exterior)

Yes
No

If yes, projected or finished date of renovation.

/

Please provide approximate years of updates or repairs to the following:

Plumbing System *

Electrical System *

Roofing *

Exterior

Roof *

Type of Fuel

Please Enter Yes or No for the following Questions

Do you have any supplemental heat such as a wood, coal, pellet or gas stove?

Yes
No

Does your home have a security system?

Yes
No

Homeowners Insurance does NOT cover floods/earthquakes. Would you like to receive information on Flood Insurance?

Yes
No

Is your basement Finshed ?

Yes
No

If Yes, Approximate value of the finished area

Do you have a sump pump? *

Yes
No

Do you have Backup of Sewer and Drain Coverage?

Yes
No

If yes, do you need higher limits on Sewer or Drain Coverages?

Yes
No

Do you have any structures on the property that are not attached to your home—such as a garage, pool house, cabana, gazebo, pergola, sports court, and outdoor living area (built in barbeque or rock/masonry seating areas)? *

Yes
No

Do you own any boats, jet skis, recreational vehicles, snowmobiles, ATV’s or golf carts? *

Yes
No

Do you own any items valued over $1,000? (i.e. Furs, Fine Arts, Guns , Coins, Other Collectible Items) *

Yes
No

Jewelry

Yes
No

Furs

Yes
No

Fine Arts

Yes
No

Sliverware

Yes
No

Guns

Yes

Electronics

Yes
No

Musical Instruments

Yes

Coins / stamps

Yes
No

Cameras

Yes
No

Other Collections

Yes
No

Is there any type of business activity in the home or on the premises? Activities such as in-home daycare, babysitting services, home-based office, farming operations (owned or leased) or garage operations?

Yes
No

Do you have professional tools or equipment on your premises for business use? *

Yes
No

Do you have a pool on your property? *

Yes
No

If yes, is it an In-ground or Above-ground pool?

In-ground
Above-ground

Is the pool fenced or have a locking or removable ladder?

Yes
No

Do you have a ..... ?

Trampoline *

Yes
No

Skate Ramp

Yes
No

Tree House

Yes
No

Other Recreational Structure

Yes
No

Are any of your children attending school away from home? *

Yes
No

If yes, number of students attending school away from home:

On or off campus?

On
Off

Do they have high value items with them at school?

Yes
No

Identity theft is one of the fastest growing crimes. Statistics show there are more that 15 million victims a year and over $50 billion in damages. Identity Theft resolution services are offered by many insurance carriers.

Would you be interested in receiving information to add this protection?

Yes
No

Have you refinanced or paid off your home? *

Yes
No

If yes, Do you have a water intrusion alarm or battery back up?

Yes
No

Are any members of your household living in an assisted living facility?

Yes
No

Do you have a vacation home or 2nd residence?

Yes
No

Important Concerns

Is the Liability Limits of your Policy Adequate to cover your Personal Assets in the event of a Lawsuit?

Yes
No

Have you made any major lifestyle changes that might alter your insurance needs? Marrying, Divorcing or Retiring?

Yes
No

Have you changed the ownership structure on your property? (Started a Trust or an LLC?)

Yes
No

If you have Life Insurance, do you have enough coverage to pay off your home mortgage?

Yes
No

Do you have Long Term Disability Insurance to Protect you family if you were disabled?

Yes
No

Are you interested in protecting your retirement assets with Long Term Care Insurance?

Yes
No

Ask yourself, “How will my family manage financially if I die?” We have affordable insurance plans and life insurance rates have dropped significantly within the past few years.

Do you have the protection that your family will need to maintain their lifestyle or pay for college? When was the last time you had a financial check-up?

Additional Notes, Information & Instruction