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5727 N Division St, Spokane, WA 99208, USA
(509) 483-3030
info@northtowninsurance.com
Why NTI?
About Us
Meet The Team
Questions to Ask Insurance Agents
Career Opportunities
Community Events
Leave A Review
Products
Personal
Commercial
Get Quotes
Get Quotes
Our Blog
Client Center
Request Change or Service
Request New Quotes
FAQ – Car Insurance
FAQ – Home Insurance
FAQ – Business Insurance
FAQ – Claims
Insurance Renewal Review
NTI Rewards – Referral Program
Service Center
Start A Quote
Start A Quote
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Policy Review – Home & Auto
Accepting Coverages
*
Yes, I have.
Not Interested.
Your input is essential to eliminate gaps in your insurance coverage. Please accept that you have reviewed your policy, you accept your coverages and you have addressed any questions you have had with our team and/or insurance carrier. This checklist is used prior to the renewal of your insurance policy(ies) for the purpose of verifying your coverage is up to date to protect against losses. This checklist does not cover every situation, but it is a good starting point to prompt you to consider major items or questions.
Date
MM slash DD slash YYYY
Client Name / Primary Named Insured
*
First
Last
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Mailing or Physical Address Changes
If you’ve had any changes to your mailing address, or physical address, please include them here.
Phone – Best#
*
Text Messages
*
Yes – Approved
No – Do Not Text
Please let us know if you approve contact via text message.
Email
*
Please include your email address to get a copy of this form and instructions on our next steps.
Preferred Method of Contact
*
Text
Email
Schedule Phone Call
Household Drivers
*
Have there been any change in your household drivers? Ex. Drivers regularly using your vehicle, drivers that have moved out.
Household Vehicles
*
Have there been any changes in the vehicles listed on your policy? Ex Vehicles sold, purchased, in storage, loaned out, customized or altered, refinanced or a loan paid off
Custom Equipment
*
Do any of your vehicles have custom equipment that you want to add coverage for? Ex. stereo systems, after market parts or grill guards, etc.
Other Vehicles & Business Use
*
Do you often drive vehicles owned by others, including your employer’s vehicle? Or use your vehicle(s) for business reasons? Do you use your vehicles for ride-share Lyft, Uber, Turo or other?
Annual Miles – Low Mile Discounts
*
Please list the estimated annual miles of your vehicle(s). I.e.: 2005 Jeep – 5000 miles
AAA Roadside Discounts
*
Are you a member of AAA Roadside?
Purchased Property
*
Have you bought or sold a house, vacation property, farm, vacant land?
Mortgage Company
*
Have there been any recent changes in your mortgage company information? Does anyone, except a mortgagee, have financial interest in your home?
Home Business
*
Do you have any hobbies or conduct any business from your home that grosses more than $2000 per year? *There are limitations and exclusions for businesses at home, in your garage or renting out space to others for business purposes.
Home Updates
*
Have there been any additions or updates to your home? Ex remodeling, improvements, updates to the water, heating, plumbing, electrical or roof? *Is the amount of insurance on your home less than it would take to rebuild it?
Home – Outbuildings
*
Is there enough “Other Structures (Coverage B)” to cover all outbuildings, shops, sheds, detached garages, carports, fences, awnings, etc?
Valuables
*
Do you have any antiques, fines arts, silverware, collectibles, valuable jewelry or furs? Or sporting equipment, guns, musical instruments? *Many policies have limitations to the coverages available for these items, unless they are scheduled.
Safety/Smart Features
Burglar Alarm
Centrally-Monitored Alarm System
Fire Alarm
Fire Extinguisher
Smart Water
Smart Thermostat
Have you added any of the following to your home? Check all that apply.
Specialty Features
*
Does your home have any specialty features? Ex wine vault, home theater, Jacuzzi, skylights, pool, etc
Home Sharing
*
Do you rent your home as part of a home-sharing/renting program like AirBnb, VRBO or other?
Are you interested in: "It COULD happen to me coverage"?
*
The purpose of an Umbrella Policy is increasing your limits of liability AND potentially filling gaps that your home or auto insurance won’t cover. If you don’t have an umbrella policy, we’ll give you 4 reasons we strongly encourage it – potential coverage for fun gone wrong: 1. Hosting social gatherings where alcohol is involved. 2. Traveling out of the country. 3. Renting/Borrowing toys (ATVs, JetSkis, Boats). 4. The cost is generally less than paying for one hour of an attorney’s time to defend you.
Other Insurance
*
Umbrella or Excess Liability Insurance
Auto
Homeowners or Renters
Water or Sewer Pipe Coverage
Flood
Boat or Personal Watercraft
Motorcycle or ATV
Farm or Agriculture
Business/Commercial
Life or Health Insurance: We do not write but can offer a referral
Not interested in other lines of coverage at this time
Are there any other coverages we can answer questions about or quote for you?
"That Reminds Me!"
I need proof of insurance
I need to make a change to my policy (comment below)
I have a general question (comment below)
If it’s not related to your renewal, but reminds you of something about your insurance, please let us know how we can help:
Comment: Changes, General Questions, Proof of Insurance
Please describe how we can help with something unrelated to your policy renewal.
Feedback
*
Do you have any feedback for us? Is there an area we can improve your experience? Is there a team member you’d like to give kudos to for their effort?
Name of person completing this form:
*
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Email
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