Renewal Client Update PL Renewal Form CL Renewal Form PL Renewal Form Step 1 of 12 8% Name(Required) First Last Email(Required) Are you driving for a rideshare or delivery company?(Required) Yes No If yes what company?(Required) Have you started using your vehicle for business?(Required) Yes No (Roofing, real estate, advertisement, etc.)What Business?(Required) Please check all situations that apply to you.(Required) Address Change Birth of a child Career Change Driver Added Driver Removed Home renovations/improvments Marital Status Purchased ATV/Motorcycle/Slingshot Purchased Boat Purchased Home/Rental Property/Second Home Started A Business Vehicle Bought Vehicle Sold No Changes Date Moved? Updated Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name Birthday Congrats on the new career! What is your new job title?(Required) Add Driver To Policy First Last Birthday Relation DL # Car Driven Annual Miles Remove Driver From Policy First Last Reason Why What is your current marital status? Married Divorced Widowed Spouse Name What new toy(s) did you purchase? ATV Boat Golf Cart Motorcycle Slingshot List make, model and estimated purchase price for each new toy. Add RemoveClick the + to add more rows. What type of property did you purchase?(Required) Primary Home Rental Home/Investment Property Second Home/Vacation Home Date Purchased MM slash DD slash YYYY New Property Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is the Property currently insured? With who? What is the name of your new business? What is the industry of your new business? Date Purchased MM slash DD slash YYYY Year/Make/Model of purchased vehicle(s) Add RemoveClick the + to add rows for additional vehicles.Date Sold MM slash DD slash YYYY Year/Make/Model of sold vehicle(s) Add RemoveClick the + to add rows for additional vehicles. Please list the renovations and an approximate cost of each. Add RemoveYou can use the + button on the right side to add additional rows. Are there any additional changes that we should know about prior to your insurance renewal?Section BreakSection BreakEmailThis field is for validation purposes and should be left unchanged. CL Renewal Form "*" indicates required fields Full Name:* First Last Business Legal Name (and DBA, if applicable): Phone Number:*Email Address:* Mailing/Correspondence Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are there any significant changes in your business operation since we last spoke? (Merger/Acquisition, New lines of business, new categories of operation, etc.)How many W-2 employees does your team currently have?* What is your projected total W-2 payroll for the upcoming 12 months?* What is your projected gross revenue for the upcoming 12 months?* What is your projected total paid to subcontractors or 1099 team members for the upcoming 12 months? (if applicable) If you have acquired any new property, added locations, or made other changes that effect your insurance needs, please detail them here.We maintain an extensive network of local professionals to help our clients with many potential needs. Please check any box below for any service you'd like a personal introduction to one of our Channel Partners in that area. Health or Life Insurance Agent Financial Advisor C.P.A. or Accountant Bookkeeping Service Attorney (all categories) Commercial Lender Commercial Real Estate Agent Commercial Property Manager Banker Hard / Private Money Lender Mortgage lender Residential Real Estate Agent Residential Property Manager Roofer Construction / Home Builder Handyman / Routine Housework Automobile Sales Automobile Service / Repair Moving Company Landscaper Electrician Plumber Heating and A/C Service / Repair Pool Service / Repair Pest Control / Exterminator Marketing agency Physician (All Specialties) Dentist Chirocractor Physical Therapist Computer Service / Repair Web Design / SEO Consulting Do your renewal policies need to be submitted to L&I? Do we need to add any additional insured's to your policy? (Bank, landlord, new contracts, etc) My business is built on referrals. What businessowners do you know that could benefit from my help? Is there anything else that we need to know now to make sure your insurance program is exactly what you need?You may upload up to 3 files to us, if necessary. Drop files here or Select files Max. file size: 100 MB, Max. files: 3.
