Annual Insurance Policy Review | Coastal View Insurance

Contact Info

First & Last Name ✶

Email ✶

Phone ✶

Has your phone and/or email address recently changed? ✶

Yes No

Have you recently moved? ✶

Yes No

New Address

City

State

ZIP Code

Family Changes

In the last 12 months, have any of the following changed:

Marital status changed

Employment

Household size

Covered Children

Do you have children young enough to still be covered by your insurance policy? ✶

Yes No

Have any of your children started, or will start within the next 12 months: ✶

Driving

Attending College

Renting an apartment or house

Auto Insurance

How many cars do currently you own or lease? ✶

In the next 12 months, do you plan to:

Drive significantly more or fewer miles per year

Buy, lease, or sell a car

Use one of your cars for delivery or ride-share services (Uber/Lyft, DoorDash, InstaCart, etc.)

Home Insurance

In the last/next 12 months, did/will you:

Add solar panels, a backup generator, or home batteries

Make any significant changes or improvements to your home (pool, roof, finished basement, additions, etc.)

Add a home security system

Make any large item purchases that might require additional coverage (artwork, antiques, instruments, jewelry, etc.)

Start a home-based business

Move and/or build a new home

Purchase a 2nd/vacation home

Rent out your home (like Airbnb, Vrbo, etc.)

Anything Else

Are there any other insurance coverages you would like to discuss?

Do you have any questions about your current coverage?

Are you interested in changing your coverage amounts, deductibles, or insurance company this year?

Are you happy with your experience with Coastal View Insurance?

Yes No

Comments about your experience with Coastal View Insurance that you'd like to share

Binding Agreement

I understand that insurance coverage is not bound or altered until I receive confirmation by an authorized representative of Coastal View Insurance ✶

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Annual Insurance Review

Coastal View Insurance

Contact Info

Family Changes

Covered Children

Auto Insurance

Home Insurance

Anything Else

Binding Agreement

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