Automobile Survey 1. Do we insure all of your vehicles? * Yes No 2. Are all licensed drivers in your household listed on this policy, including permitted drivers? * Yes No 3. Do you have a vehicle, not your own that would be available for you to use? (i.e. Rommate’s car) * Yes No 4. Do you own any camping or recreational vehicles? (4-wheelers, snowmobile, fifth-wheel, or pop-up camper) * Yes No 5. Are any of your vehicles titled to a business or someone other than yourself? * Yes No 6. Do you own a van or pickup that has any customized equipment? * Yes No 7. Has there been any change in miles driven to work? * Yes No 8. Do you have any children in college? If 'No', skip to Question 10. * Yes No 9. If 'Yes' on question 8, do they drive their car to and from college? Yes No 10. Have you considered increasing your deductibles to lower your premium? * Yes No 11. Are you interested in saving money on your auto insurance if we can write your home? * Yes No 12. Do you have any problems, questions or concerns? * Yes No 13. Has any driver had any tickets in the past twelve months? * Yes No Name: * Policy #: Phone #: * Email: * Date: * ** Please list all members, drivers or not, in household, date of birth and relationship: (Please hit enter after each listing) * reCAPTCHA If you are human, leave this field blank.
