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Pledge Insurance Services
Secure Form

Secure Personal Renewal Review Form

Help us prepare for your personal lines renewal by answering the questions below.

Your Name:
First
Last
Email Address:
Phone Number:
5 Digit Zip:

Home Information

Have there been any changes in your household residents?

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

Do you operate any business out of your home?

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

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

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

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

Auto Information

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

Does anyone in your household drive a company car?

Does anyone in your household own a collector vehicle?

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

Rental and/or Secondary Property

Have you updated the property in the last year?

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

Do you do short term rentals?

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

Do you own any vacant land?

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

Miscellaneous Information

Would you recommend the Pledge Insurance Services Team 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 your are receiving from the Pledge Insurance Services
Agent Name (Optional)

Website Disclaimer — Review Carefully

This is a solicitation for insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voicemail, text 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.

Accessibility: If you have difficulty using this form, call 800-400-9278 or visit our contact page.