Skip to content
Our Brands
Bear River Mutual® Insurance
Progressive® Insurance
Safeco® Insurance
Travelers® Insurance Orem Utah
Auto Owners Insurance
The Hartford Insurance
Mutual of Enumclaw Insurance
United Insurance Orem Utah
Products
Auto Insurance
Business & Commercial Insurance
Dental Insurance
Earthquake Insurance
Homeowners Flood Insurance
Homeowners Insurance
Motorcycle Insurance
Recreational Vehicle Insurance
Renters Insurance
Watercraft & Boat Insurance
About Us
About Us
Areas We Serve
Client Reviews
Our Blog
Contact Us
Client Portal App
Billing And Claims
Provo Office
Payson Office
Join our Newsletter
En Espanol
Start a Quote
(801) 852-5555
Our Brands
Bear River Mutual® Insurance
Progressive® Insurance
Safeco® Insurance
Travelers® Insurance Orem Utah
Auto Owners Insurance
The Hartford Insurance
Mutual of Enumclaw Insurance
United Insurance Orem Utah
Products
Auto Insurance
Business & Commercial Insurance
Dental Insurance
Earthquake Insurance
Homeowners Flood Insurance
Homeowners Insurance
Motorcycle Insurance
Recreational Vehicle Insurance
Renters Insurance
Watercraft & Boat Insurance
About Us
About Us
Areas We Serve
Client Reviews
Our Blog
Contact Us
Client Portal App
Billing And Claims
Provo Office
Payson Office
Join our Newsletter
En Espanol
(801) 852-5555
Start a Quote
Start a Quote
Menu
Life Changes
What Type of Quote Are You Looking For?
Builders Risk Quote
Business Quote
General Liability Quote
Workers Compensation Quote
Bond Request Form
Dental Insurance Quote
Earthquake Quote
Homeowners Insurance
Homeowners Flood Insurance
Life Insurance
Motorcycle Insurance
Recreational Vehicle Insurance
Watercraft & Boat Insurance Information
Have a Question?
"
*
" indicates required fields
Life Changes Simple Survey
You are important - and we are grateful for your business! Thank you for taking a moment to tell us some more about you and what's been going on in your life over the last year.
Name
*
First
Last
Phone
*
Email
*
Has Your Mailing Address Changed?
*
Yes
No
Address
*
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Have You Had Any Life Changes Since Your Last Renewal
*
Please let us know about life changes such as: New child, Employment change, New driver/ teen driver in the household, Acquired or sold any vehicles (including RV, trailer, boat, motorcycle) Purchased or sold real estate, Created a living trust,
Yes
No
Tell Us About Your Life Changes
*
Has Your Marital Status Changed
*
Yes
No
Please Provide Details
*
(Date, Location, ETC)
Own a Business
*
Yes
No
What Type of Business Do You Own
*
Have You Earned a Degree or Certification
*
Higher education can potentially add up to additional savings. This includes college, military MOS training, and vocational certifications (cosmetology school, journeyman/apprenticeship program, trucking school, etc).
Yes
No
Type of Degree or Certification
*
Have Your Driving Habits Changed
*
If you were commuting to work, but now work from home you could receive an additional discount. Are you using your car for work (Uber driver, contractor going from site to site, realtor, etc) and/or are you advertising for your business on your vehicle? These factors could have extra exposure and coverage concerns that we would want to advise you on to ensure you are properly protected.
Yes
No
Tell Us About Any Changes In Driving Habits
*
Would You Like to Save up to 40% by Bundling your Home and Auto?
*
Bundling your Home & Auto can save you up to 40%. Simply select Yes to see how much money you can save.
Yes
No
I Already Bundle!
Would You Like a Quote for Flood Insurance
*
Flood is EXCLUDED on all home insurance policies. 25% of flood losses happen in low risk flood areas.
Yes
No
I Already Have Flood Insurance
Have You Completed Any Home Improvements to Your Home
*
New roof, kitchen/bathroom upgrades, additional square footage, etc...
Yes
No
N/A
When Was the Last Time You Replaced Your Roof?
*
Tell Us About Your Home Improvements
*
Do You Have Any Special Personal Property or Items of High Value
*
Items such as jewelry, weapons, fine arts, fur coats, musical equipment, fine china, high-end bicycles may require special coverage to protect you against theft, breakage or mysterious disappearance. Would you like a quote to provide coverage for special personal property? Most homeowner policies limit coverage on these categories to $1,500 - $2,500 TOTAL per category.
Yes
No
I Already Have A Special Personal Property Policy
List the Items and Approximate Value
*
Would You Like a Quote For an Umbrella Policy (Additional Personal Liability Coverage)
*
Personal Umbrella Liability Coverage is sometimes referred to as lawsuit coverage and helps to protect your assets in the event that someone tries to sue you for bodily injury, property damage and even personal injury. $1M of Personal Umbrella protection can cost as little as $250/year. Our agency HIGHLY RECOMMENDS that you consider this important and inexpensive coverage.
Yes
No
Already Have One
Are You Interested In Receiving An Affordable Life Insurance Quote
*
Do you have Life Insurance outside of your employer? Many times this Life Insurance does not follow you if you leave the job. This small and simple action can leave a lasting legacy and financial protection for your family when you pass away.
Yes
No
Already Have One
Are you Interested in Reviewing Health Insurance Options
*
Even if you're currently insured, its worth having a review of your current coverages/costs We can help with: Individual Major Medical, Medicare, Short Term, Injury, Dental/Vision, Group, Health Sharing Ministries, Limited Medical, ETC
Yes
No
Already Have One
Additional Items to Insure
RV
Boat/Jet Ski
Motorcycle
ATV
Rental Property
Vacation Home
Other
Great! Let Us Know What We Can Quote For You
*
Is There Anything Else We Should Be Aware of As Your Renewal Approaches
Documents to Upload if Needed
Drop files here or
Select files
Max. file size: 39 MB.
Comments
This field is for validation purposes and should be left unchanged.