Important insurance information for COVID19

855.207.9492

Coverage Review

To begin our annual coverage review for your renewal, please complete the below questionnaire as completely as possible so we can understand your insurance needs for the next year. Once you submit your response, a Montgomery & Associates representative will reach out to you with any additional questions prior to shopping the market for competitive rates and plans. As an independent agency, we partner with carriers such as MetLife, Cincinnati, Westfield, Selective, and Auto Owners.

Personal Information

First Name

Required

Last Name

Required

ZIP / Postal Code

Required

Primary Phone Number

Required

E-Mail Address

Required

How would you like our Team to communicate with you as your renewal approaches and we perform a market check to determine that your rates are competitive?

Optional

In the event of an emergency, who outside of your household should be notified? Please provide name, contact phone number and email, and relationship.

Optional

Do you have a home or business central monitoring system notifying the policy or fire department?

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If so, which provider is used?

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Is your home titled in a Trust or to someone other than you or your spouse?

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If home is titled, please provide the LLC information.

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Do you rent any part of your home or other buildings on your property to anyone?

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Do you use any part of your home or other buildings for business purposes?

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To help prevent home insurance premium payment delays, we will need:

Mortgage provider name

Optional

Mortgage provider loan number

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Please provide/confirm the following for us as it pertains to any properties you own that we insure

Age of roof

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Age of HVAC

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Plumbing updates

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Has your home value increased or has there been any remodels over $5,000 in the last 12 months?

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If so, please provide further details.

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Do you intend on renovating your home or business in the next 3 to 6 months?

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If so, please provide further details.

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Do you have any dogs on any premise you own?

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If yes, what breed?

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Do you have any collectibles such as antiques, fine arts, stamps, coins, baseball cards, valuable jewelry, furs, sporting equipment, guns, or silverware that you need protected? (Please list below or send in a separate email.)

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Do you have any Business Personal Property kept in your home or other structures or operate a studio or office in your home?

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If so, please provide further details on content.

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Do you own a business not insured by us?

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What type of business? Who insures it?

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Do you have clients who come into your home to purchase products or services?

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Is your household income greater than $150K?

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Do you have anyone employed that may need Workers Compensation coverage?

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Do we insure all the vehicles you own?

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If not, who does?

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Do you have children away at college?

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Living in a dorm? Off campus?

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Do they have a vehicle with them?

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Attending full time?

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Would you like towing or roadside assistance in the event of a breakdown?

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Please provide a list, if the answer is yes to the above listed question.

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Imagine a bad auto accident, the other party sues for $850,000, would you want to be covered?

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Do you own a trampoline or swimming pool?

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Do you own any of these items NOT insured by us: Boat, motor home, camper, motorcycle, golf cart, four-wheeler, other recreational item or aircraft?

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Flood insurance is an optional coverage. If a flood occurred would you like your home, personal property, or business insured?

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Do you have Life or Disability insurance other than employer provided?

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If so, please provide whether policy is term or permanent.

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We offer a complimentary review of your policies. Would you like an advisor to contact you?

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On a scale of 1 to 10, please rank your financial advisor (10 being the best)?

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Are you satisfied with the level of contact and communication from your advisor?

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Has Montgomery & Associates met or exceeded your expectations?

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If no, please provide further details.

Optional

Submission Validation

Required

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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Location

Brentwood Office
1730 General George Patton Dr
Suite 212
Brentwood, TN 37027
Local: 615.829.8457
Toll-Free: 855.207.9492