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Condo Insurance Protection Questionnaire


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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E-Mail Address
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Policy Information
Have you remodeled your home, added any additions, built any outbuildings or garages, or made any improvements to finish your basement?
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I want to make sure I am SAVING all the money that I can on my policy. I have the following in my home:
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I would definitely consider INCREASING my deductibles to lower my premium.
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Every insurance policy has internal sub-limits. I own some of the following and need a quote for scheduling these items to my homeowners policy, if not already covered:
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These coverages are excluded unless added by endorsement. Please give me a quote for scheduling these items to my homeowners policy, if not already covered:
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Do you own farm land or vacant land?
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I am completely satisfied with my current personal property limits.
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I own my own business, which is not currently insured through Alan Galvez Insurance. Please call me to discuss providing a quote
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I own the following and would like a quote for insurance:
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Are you a director or member of a non-profit board of association?
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People are 30 times more likely to lose a home because of death of a spouse. Please call me to discuss providing a quote for life insurance.
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I have or have added the following:
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My home is now titled in a trust
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Trust name
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I need to schedule a review of my insurance plan. Please call me.
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Umbrella Risk Questionnaire
I would be interested in obtaining information on a $1 million umbrella liability policy that would provide valuable protection in the case of a catastrophic accident for as little as $150.00 per year.
Required

I would be interested in increasing my current umbrella liability limit.
Required

Agency Grade Card
Your input is very valuable to us. Please take a moment to tell us how we’re doing.
If you had to grade our agency’s overall performance in providing the service you expect from us, what grade would you give?
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If you selected anything less than 5 stars, is there something we could do to improve our score?
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What do you like best about doing business with Alan Galvez Insurance?
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Do we have your permission to use your answer above in the
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May we use your name and city?
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Submission Validation
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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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CONTACT INFO

Alan Galvez Insurance
134 W. Columbus Ave.
Bellefontaine, OH 43311

 (937) 592-4871

 info@galvezinsurance.com

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