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Auto Checklist
Recent life changes can open up your eligibility for discounts or leave you inadequately covered. We can help you keep your insurance coverage up-to-date by conducting an insurance review. Please answer all questions. Thank you for your time!
Name
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Middle
Last
Address
Street Address
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City
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Phone (insured)
Phone (spouse)
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Would you like to receive text messages?
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Policies currently with Oberryman Insurance Agency (select all that apply)
Auto
Renters/Condo
Wedding
Home
Dwelling/Fire
PAF
Boat
Flood
Umbrella
Commercial Policy
Commercial Auto Policy
General Liability
Workers Compensation
Motorcycle
RV
Landlord
Please select YES or NO.
Do any of your vehicle(s) have an anti-theft device?
Yes
No
Has your daily commute changed?
Yes
No
By how much?
Do you have children at or nearing driving age?
Yes
No
Has your car loan been recently paid off?
Yes
No
Are you considering buying or leasing a new vehicle?
Yes
No
Do you have any customization of vehicles including, but not limited to, personal car wraps?
Yes
No
Has your health insurance plan changed recently?
Yes
No
Does your auto policy list all drivers?
Yes
No
Do you have any other policies that are not currently insured with us?
Yes
No
Do you have young drivers on your policy who have a strong A/B average?
Yes
No
Do you have young drivers on your policy who have completed a driver-training course?
Yes
No
Have you been free of accidents, violations and/or claims in the last 3 years?
Yes
No
Do you know anyone else who could benefit from a no-obligation insurance review from our agency?
Yes
No
Please provide their contact information below:
Would you like to discuss adding Medical Expense Coverage?
Yes
No
Would you like to discuss adding Loss of Income Coverage?
Yes
No
Would you like to discuss adding GAP Insurance?
Yes
No
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