Insurance Renewal Questionnaire

Please complete this short questionnaire for your renewal. Note that answering these questions will not change or alter your insurance coverage.

Do you own your building?

Yes

*If your building is leased or you work out of your home, please mark the answer “no”

Do you have any employees?

Yes

*If you have 1099 contractors, please answer the question “yes”

Do you have any mobile equipment?

Yes

*This does not include things like cell phones, tablets, or laptops

Have your gross sales or payroll changed from last year's insurance term?

Yes

Has your business operations changed in the past 12 months?

Yes

*This could include expanded operations or new services offered

Do you offer your employees a benefits package?

Yes

Do you have "Key Man" insurance?

Yes

*This is a type of continuity insurance for your business should something befall the principal owner or “key” employees, to ensure that your family is taken care of.

Please complete the form below for a quote.

What would you like a quote for? Check all that apply:*
- Auto
- Home
- Condo
- Renters
- Rental Property
- Life
- Motorcycle
- Boat & Jet Ski
- Umbrella
- Business Owners Package
- Work Comp
- Contractors Insurance
- Other
Primary Policyholder Name*
First Last
Your Phone Number*
Your Email*

How did you find our agency?*
- Google Search
- Facebook Page/Post
- Facebook/Instagram Ad
- Google Ad
- Customer Referral
Who referred you to us?*
Current Insurance Provider*
Date Quote Needed*
MM slash DD slash YYYY
If you have any other questions, comments or requests, please leave them here, thank you!
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Are you ready to save time, aggravation, and money? The team at Muir Insurance Group is here and ready to make the process as painless as possible. We look forward to meeting you!

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