Home and Auto Renewal Survey

1. Bancorp Insurance Personal Insurance Review

1. Bancorp Insurance insures all the vehicles you use.

Bancorp Insurance insures all the vehicles you use. No

Yes

No, please give me a quote.

Please give us the make, model, and year of vehicle to insure.

2. Do you use any vehicles on a regular basis that are not registered in your name, or your spouses name?

Do you use any vehicles on a regular basis that are not registered in your name, or your spouses name? Yes

If yes please describe vehicle and who owns it.

3. Do you have any drivers in your house hold that are not listed on your auto policy?

Do you have any drivers in your house hold that are not listed on your auto policy? Yes

If yes please list their names, date of birth, and license numbers below.

4. I have a company vehicle furnished for my regular use.

I have a company vehicle furnished for my regular use. Yes

If yes please give us the make, model and year of the vehicle. Also who is the owner of the vehicle and the insurance company name who insures it.

5. WARNING Non factory installed equipment (rims, stereo, tv/dvd player etc.) is not automatically covered without adding coverage for it. Would you like this coverage added?

WARNING Non factory installed equipment (rims, stereo, tv/dvd player etc.) is not automatically covered without adding coverage for it. Would you like this coverage added? Yes

If yes please provide us with a short description of the items you are adding and how much coverage in a dollar amount do you need to replace the specialty equipment.

6. In the event of a substantial personal liability judgment against you, how important is it to you to have a liability limit that will protect your assets from law suit?

In the event of a substantial personal liability judgment against you, how important is it to you to have a liability limit that will protect your assets from law suit? Not at all

Moderately

Very Important

7. Do you feel your current liability limits on your auto policy and your homeowners is adequate to protect your assets?

Do you feel your current liability limits on your auto policy and your homeowners is adequate to protect your assets? Yes

8. If you answered no to the above question how much liability coverage do you think you should have?

If you answered no to the above question how much liability coverage do you think you should have? $250,000

$300,000

$500.000

$1,000,000 or more.

9. Would you like information on purchasing $1,000,000 personal umbrella coverage which can cost you as little as $200.00 a year.

Would you like information on purchasing $1,000,000 personal umbrella coverage which can cost you as little as $200.00 a year. Yes