Client: New Quote - Umbrella - North Town Insurance

Client Quote - Umbrella

Thank you for letting us assist with your umbrella insurance! Please complete the information below, to the best of your ability. Most carriers require having an active auto insurance policy in order to write the Umbrella. With that said, we will be quoting the Umbrella policy with the company that your auto policy is with. Our goal is to have a QUOTE TO YOU BY THE END OF THE NEXT BUSINESS DAY.

Named Insured(Required)

First Last

Please let us know who the named insured (primary insured) should be.

Occupation & Employer

Any Lawsuits or Major Claims

Underwriting Question: Have there been any major claims or lawsuits in the past 5 years?

Vehicles Owned & Insured

Underwriting Question: How many vehicles are owned (including motorhomes) and are they all currently insured?

Youthful (under 25 yoa) or High Risk Drivers

Underwriting Question: How many drivers under 25 years old? Are there any High-Risk drivers with tickets for DUI, Reckless Driving, etc)?

Property Owned & Insured

Underwriting Question: How many properties are owned (primary home, secondary, rentals, vacant land) and are they all currently insured?

Recreational Vehicles

Underwriting Question: List any recreational vehicles owned (boat, ATV, motorcycles, RVs). Are they currently insured?

Household Staff

Underwriting Question: Do you employ household staff (nannies, landscapers, caregivers)? If so, please describe.

Pets

Underwriting Question: Do you own any pets? If so, please list the breed and if there's a bite history.

Desired Coverage Limit(Required)

$1,000,000

$2,000,000

$5,000,000

Other

Please let us know what coverage limit you would like quoted.

Notes / Requests / Questions for us

Your Name(Required)

Please share who is filling out this form?

Preferred Method of Confirmation *Include Email Address or Phone#(Required)

If you prefer the quote is sent to you via email or text, please provide that information. If you prefer a phone call, please share the phone number and best time of day for a phone call.