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Personal Policy Renewal

"*" indicates required fields

Name of Policy Holder*

Phone number*

Email address*

Are there children in the household?*

Yes

No

Age of child in the household*

Add new line for each of the children

Are there any new household members or newly licensed drivers in the household?*

Yes

No

Additional information*

Name of driver

Date of birth

License number

Occupation

Does your home have a monitored security system or local alarm?*

Yes

No

Who is your provider?*

Do you have a Boat to Insure?*

Yes

No

Boats to insure*

Year

Make

Model

CCs / horsepower

Appraised value

Do you have a snowmobile to insure?*

Yes

No

Snowmobiles to insure*

Year

Make

Model

CCs / horsepower

Appraised value

Do you have a motorcycle/RV to insure?*

Yes

No

Motorcycle/RV to insure*

Year

Make

Model

CCs / horsepower

Appraised value

Do you own a seasonal home?*

Yes

No

More Info*

Do you have a pool?*

Yes

No

Pool Size*

Max Depth*

pool is above ground?*

Yes

No

Is your pool fenced?*

Yes

No

Does the pool have a slide?*

Yes

No

Is there a diving board?*

Yes

No

Do you have a trampoline?*

Yes

No

Do you have a net around the trampoline?*

Yes

No

Any updates to the roof?*

Yes

No

What year was the update?*

What work was done?*

Any updates to the electrical?*

Yes

No

What year was the update?*

What work was done?*

Any updates to the plumbing?*

Yes

No

What year was the update?*

What work was done?*

Any updates to the hot water heater?*

Yes

No

What year was the update?*

What work was done?*

Any updates to the bathrooms?*

Yes

No

What year was the update?*

What work was done?*

Any updates to the kitchen?*

Yes

No

What year was the update?*

What work was done?*

Any updates to the basement?*

Yes

No

What year was the update?*

What work was done?*

Any additions to the home or any newly built structures on the premises?*

Yes

No

Provide details*

Do you have a mortgage?*

Yes

No

Who pays the home insurance?*

paid by owner

escrowed with your mortgage payment

Are there any dogs on premises?*

Yes

No

How many dogs?*

What breed(s)?*

Have you purchased any high ticket items in the last year?*

Yes

No

Jewelry, electronics, collectables etc

Provide details and value*

Are any vehicles used for Uber, Lyft, Shipt or delivery?

Yes

No

More info*

Any vehicles not titled to you or your spouse?*

Yes

No

Details*

Do any vehicles have any business logos or signs on them?*

Yes

No

More details*

Has your medical insurance changed in the last year?*

Yes

No

Name of the provider*

Is this a waterfront location?*

Yes

No

Do you have a seawall?*

Yes

No

Do you want sea wall coverage?*

Yes

No

How much?*

details*

Would you like an Umbrella Quote?*

Yes

No

Would you like a Flood Insurance Quote?*

Yes

No

Would you like more information on:

Medicare Insurance

Commercial Insurance

Group & Voluntary Benefits

Individual Life Insurance

Personal Health Insurance

Annuities & Financial Services

Other

Which other insurances would interest you?*

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The Salvati Insurance Group, Inc.
Monday - Friday: 8:30 A.M. -4:30 P.M.
42370 Van Dyke Ave, Suite #711
Sterling Heights, MI 48314
Phone: 248-720-1130

The Salvati Insurance Group is proud to be named one of the Best and Brightest Companies in the NATION to Work for in 2022, 2024 and the Metropolitan Detroit for 2021, 2022, 2023 and 2024. Our commitment to a culture of excellence is reflected in all we do and extends far beyond the walls of our office.