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Personal Insurance Checklist


Your insurance needs are like a puzzle, impossible to complete without all the pieces.  Please take a moment to complete this insurance checklist to help us make your insurance program right for you.

First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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E-Mail Address
Required
Would you like to schedule an appointment for a review of all your insurance needs?
Optional
Have you made any alterations or additions to your home?
Optional
Do you have collectibles such as antiques, fine art, stamps or coins?
Optional
Do you own costly sporting equipment or firearms?
Optional
Do you own valuable jewelry or furs?
Optional
Do you own high value photography equipment?
Optional
Are you comfortable with the present coverage limits on your homeowners policy?
Optional
Do you have an active central station alarm?
Optional
Do you own a business?
Optional
Do you keep tools or equipment used in your business in your home?
Optional
Do you operate an office or studio in your home?
Optional
Do clients visit your home?
Optional
Do you provide child care for a fee in your home?
Optional
Have you repalced your roof within the last 10 years?
Optional
Do you have a wood burning stove?
Optional
Do you have a swimming pool?
Optional
Do you own rental or investment properties?
Optional
Do you own any vacation properties?
Optional
Do we insure all your vehicles?
Optional
Does your auto policy list all the drivers in your household?
Optional
Do you own an auto with custom equipment?
Optional
Would you like emergency roadside assistance coverage?
Optional
If your vehicle was involved in an accident would you like coverage for a rental vehicle while yours is being repaired?
Optional
Are you comfortable with the present coverage and limits on your auto insurance policy?
Optional
Do you own any items on this drop down list?
Optional
Do you have a personal umbrella liability policy?
Optional
Do you have health insurance?
Optional
Do you have disability income insurance?
Optional
Do you have life insurance?
Optional
If you rent, do you carry renters insurance?
Optional
Do you carry flood insurance for your home and contents?
Optional
Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Mailing Address
32646 Five Mile Rd
Livonia, MI 48154
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734.522.3900
info@metroagency.net
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734.522.3900
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