| General Information:
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| Name: |
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Disclaimer: No insurance coverage or policy change will take effect until a Hoffman Group associate advises you by phone or through written communication that coverage has been placed. If you need immediate service, please call us at (800) 826-4006. |
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| E-mail:
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(we do not sell e-mail addresses) |
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| Would you like to know how to pay your premium electronically? |
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| If we don't write both your home & auto insurance, would you like a quote to see if we can save you money? |
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| Auto Profile: (Please explain all Yes respones) |
| Does anyone in the household drive a company car? |
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| Has anyone in the household changed jobs or retired in the last year? |
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| Is anyone in the household away at school? |
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| Please provide names and birthdates for all residents in your household |
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Do any of your vehicles have a GPS, DVD or any
other special equipment? |
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| Are any youthful drivers in your household eligible for a Good Student discount with a GPA of 3.00 or better? |
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Do you pay anyone more than $160 per calendar quarter
for cleaning, babysitting, yard work or other work
around your home? |
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| Home Profile: (Please explain all Yes respones) |
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you made any updates or additions to your home such
as remodeling, new siding, security system, updated
electrical, plumbing, roof or heating that may increase
its value or qualify you for discounts? |
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| Do you own any jewelry, furs, silverware, fine arts or firearms in excess of $1000? |
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| Have you constructed or added any outbuilding, pools or trampolines? |
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| Do you own any RV's, ATV's, motorcycles, watercraft or golf carts? |
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| Do you operate any type of business in your home or outbuilding? |
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| Do you have any pets? |
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| Do you have a woodburning stove? |
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| Do you own any additional property? |
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| Is your home or any additional properties titled in the name of a trust? |
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| Do you have any insurance questions we can answer for you? |
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Disclaimer: No insurance coverage or policy change will take effect until a Hoffman Group associate advises you by phone or through written communication that coverage has been placed. If you need immediate service, please call us at (800) 826-4006. |
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