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Commercial Insurance Renewal Form

As a valued client, we want to remind you that it is critical to review your insurance policies yearly. We created this questionnaire to verify your current information and identify any changes that need to be made to your policy before renewal.

Please take a moment to complete and return the following questionnaire.

You can call us at (915) 599-2900 with additional changes or any questions you may have.

If we do not hear back from you, we will assume no changes are necessary.

First Name(Required)

Last Name(Required)

ZIP / Postal Code(Required)

E-Mail Address(Required)

Date of Birth(Required)

Is your name, as written above correct?

Have there been any recent changes in the ownership of the business?

Did you buy/ sell any building, property, machinery, or autos this past year?

Have you made any improvements to any space you lease?

Do you wish to discuss coverage on non-building property such as fences, poles, antennas, etc?

What is your expected revenue for the next 12 months ?

What is your expected payroll for the next 12 months?

How many employees do you currently have?

Do your employees ever use their autos on company business?

Do you store any confidential customer information including names, address, birth dates, social security, credit card numbers, etc?

Are you interested in discussing any of the following optional coverages?

Protection from lawsuits by your employees for allegations of discrimination, harassment, or other similar issues?

Protection from loss of computer data?

Higher limits of liability coverage?

Personal lines of coverage including home or auto?

Please let us know of any other comments, issues, or changes that you would like us to know about:

Commercial Insurance Renewal Form

If we do not hear back from you, we will assume no changes are necessary.

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