Policy Review - Auto - North Town Insurance

Accepting Coverages*
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
First Last
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone - Best#*
Text Messages*
Please let us know if you approve contact via text message.
Email
Preferred Method of Contact*
Household Drivers
Has 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 you have any custom equipment on your vehicle(s)? Ex Stereo systems, aftermarket parts, 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 Discount*
Please let us know the estimated annual miles driven by your vehicle(s).
AAA Roadside Service*
Are you a member of AAA Roadside Service?
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/Health Insurance: We do not write but can offer a referral
Are there any other coverages we can answer questions about or quote for you?
Community Partnerships
Did you know that for all referrals we receive, we donate to a local nonprofit? Is there an organization that is close to your heart that you want to share with us?
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?

Policy Review – Auto

Policy Review - Personal Auto

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