Request a Renewal or Review Form - Strata Insurance Group

Request a Renewal or Review

First Name

Last Name

Email

Phone/Mobile

Address

Zip Code

Home Information

Have there been any changes in your household residents?

If yes, please explain.

Have you added any valuable items (i.e., jewelry, firearms, collectibles) to your home in the past year?

If yes, please explain.

Do you operate any business out of your home?

If yes, please explain.

Do you keep any business property worth more than $2,500 at your residence or in your vehicle?

If yes, please explain.

Have you installed an alarm system or other protective devices in any property in the past year?

If yes, please explain.

Have you made any updates to the roof, electric, plumbing or heating in the past year?

If yes, please explain.

Have you added any additions or upgrades to the house (e.g., finishing the basement)?

If yes, please explain.

Auto Information

Have there been any changes in drivers of your vehicles in the past year?

If yes, please explain (include names, dates of birth and license numbers of any new drivers).

Does anyone in your household drive a company car?

If yes, please explain.

Does anyone in your household own a collector vehicle?

If yes, please provide year, make and model of vehicles.

Do you have any vehicles garaged at an address other than your primary residence?

If yes, please explain.

Rental and/or Secondary Property

Have you updated the property in the last year?

If yes, please explain (include values and description of work).

Is the property vacant or may become vacant for more than 30 days at a time?

If yes, please contact our office and/or tell us when we may contact you to discuss coverage concerns.

Do you do short term rentals?

If yes, please contact our office and/or tell us when we may contact you to discuss coverage concerns.

Miscellaneous Information

Have you purchased a secondary home or rental property in the past year?

If yes, please provide the property address.

Do you own any vacant land?

If yes, please explain.

Have you purchased any recreational vehicles in the past year (boats, motorcycles, RVs, etc.)?

If yes, please provide year, make and model.

Would you recommend Strata Insurance Group to your family and friends?

Would you like to schedule to a meeting to do a complete risk management review?

How satisfied are you with the service you are receiving from Strata Insurance Group?

Please share any additional comments.

Agent Name (optional)

Review carefully: This is a solicitation for insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, email, voicemail or facsimile. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent. Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.