Account Review Checklist January 13, 2020by Walter Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Have you recently performed a Mass Save (https://www.masssave.com/) audit on your home?* Yes No You may be eligible for a discount on your insurance if you have or plan to?Do you own collectibles such as antiques, fine art, stamps, coins, or baseball cards ... valuable jewelry or furs .. costly sporting equipment or firearms ... expensive cameras or other photography equipment?* Yes No Do you have any burglar or fire alarms installed in your home?* Yes No Do you have a standby generator, home temperature monitor, or sump-pump backup battery?* Yes No Do you have children away at college?* Yes No Do you own tools, equipment, or instruments used in your trade or profession?* Yes No Do you operate a business in your home?* Yes No Are you a current member of the Massachusetts Golf Association* Yes No Are you concerned about water backup through sewers or drains, or the failure of mechanical systems like central air conditioning or underground utility services?* Yes No Do you or your resident children baby-sit for a fee?* Yes No Have you recently remodeled your home or have plans to do so?* Yes No Would you like us to re-evaluate the estimated cost to rebuild your home?* Yes No Are you interested in Flood Insurance for your home and personal property?* Yes No Are you interested in Earthquake Coverage?* Yes No Are you interested in learning about coverage for Residential Fuel Tank leakage?* Yes No Are any animals or pets kept on your property?* Yes No Do you use a wood, coal, or pellet-burning stove?* Yes No Do you have a swimming pool?* Yes No Do you own rental or investment property?* Yes No Do you rent your home for any portion of the year (not including rental apartments in your multi-family home)?* Yes No Do you own a vacation residence (e.g., condo, cabin, or trailer)?* Yes No Does our agency insure all your vehicles?* Yes No Does your automobile policy list the names of all drivers living in your household?* Yes No Do you routinely drive vehicles you do not own (such as, a company vehicle)?* Yes No Do you own a vehicle with custom furnishings or equipment (i.e., not factory installed, such as a conversion van)?* Yes No Is your vehicle used in a ride-sharing (such as Uber or Lyft)?* Yes No If your vehicle were damaged in an accident, would you need your current Automobile Policy to reimburse you for a rental car while yours is being repaired?* Yes No Do you own any recreational vehicles?* Yes No Would you like to review your liability risks and how well protected you are if someone sued you?* Yes No Would you like an umbrella insurance quote to help better protect your personal assets?* Yes No Do you own a business?* Yes No Do you have Disability Income Insurance?* Yes No Would you like a no-obligation review of your personal Life Insurance needs?* Yes No Do you have Long-Term Care coverage to protect your savings from expensive nursing home costs?* Yes No Do you know anyone else who might benefit from a no-obligation insurance review from our agency?* Yes No Would you like to communicate with us by text messaging?* Yes No CommentsCAPTCHA
