Service Questionnaire

Andre-Romberg Insurance Agency – A Division of Alliant Insurance Services, Inc.

If we insure your home, please start with question 1, otherwise skip to question 7.

Required fields are marked with: *

Service Questionnaire
1) Do you feel your dwelling coverage limit is an adequate amount to rebuild your home?
2) Have you made any substantial improvements to your home in the past few years?
3) Do you have any jewelry, silverware, guns or other collectibles valued over $1,000 that need to be scheduled?
4) Do you have detached structures on your property valued at more than 10% of the home coverage amount listed on your home insurance policy?
(i.e. shop, shed, garage)
5) If you currently do not carry coverage for back up of sewer or drains coverage, would you like to add that coverage to your home policy?
6) Do you have a swimming pool or hot tub?
7) Do you or any household members operate a business from your home?
8) Do you own any rental properties, vacant land, or vacation homes that we do not insure?
9) Is the owner of the policy the registered owner of all vehicles on the policy?
10) Are you interested in a quote for higher auto liability limits?
11) Do you own any recreational vehicles?
(campers, ATV, boats, RV’s, motorcycles)
12) Would you be interested in a quote for an Umbrella policy?
13) Do you own a business? If yes, do we insure it?
Contact information
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8:00 AM - 4:30 PM M-Th
Fridays 8AM - 3:30PM
Closed daily for lunch 12-1PM