Personal Insurance Review - Keystone Insurance Brokers

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Head Office: 1074 Pittsburgh Road Valencia, PA 16059
Phone: (724)-898-2886
Email: mail@PAinsurancebrokers.com

Why Us?
Our Products
- Personal Insurance
- Commercial Insurance
Medicare
Service
Locations
Client Login
Contact

Personal Renewal Review

Your Name*
First Last
Your Address*
Street Address Address Line 2 City State ZIP Code
Your Preferred Phone Number*
Your Preferred Email Address*
Are there any significant changes in your family since we last spoke?
Home renovation, new roof, new toy (boat, golf cart, ATV), etc.
Are there any pending or potential claims situations you are aware of?
We are eager to help you determine if it's a good idea to file a claim.
Have you made any significant purchases in the last 12 months that you haven't told us about yet?
Typical high-value items missing the right insurance coverage include jewelry, electronics, furniture, firearms, art and musical instruments.
Has anyone moved into your residence since your last policy renewal who is a licensed automobile operator?*
- Yes
- No
What is their Name, DOB, and License Number*
Name DOB License # Car Driven
Has anyone moved out of your residence since your last policy renewal who is a licensed automobile operator?*
- Yes
- No
What is their Name?*
Name DOB License # Car Driven
General Life Changes that may impact insurance (check all that may apply to you or members of your household)
- Had a baby
- Got married or engaged
- Got separated or divorced
- Purchased secondary or investment property
- Someone moved in or out of your household (including child)
Homeowners Insurance Discounts (check all that may apply to you)
- Fire or Burglar alarm installed (monitored by company such as ADT, Brinks, etc.)
- Gas alarm installed (such as carbon monoxide alarm or automatic gas main shut-off)
- Water alarm
- Non-smoker
Life Changes that impact Home Insurance (check all that may apply to you)
- Completed a home remodel, improvement, or addition
- Purchased or inherited high value items like jewelry, firearms, or artwork
- Purchased an outdoor trampoline
- Began renting out your home, either on a long-term or short-term basis (like Airbnb)
- Started a home-based business or have a hobby that earns income
- Have a new dog
Please check any items that are in/on your property in the last 12 months
- Dog
- Trampoline
- Swimming Pool
- Other
- None of the above
Auto Insurance Discounts (check those that may apply to you or members of your household)
- Driver Safety Course Completion (age 55+)
- AAA Member
- Good Student (3.0 GPA or higher)
- Child away at college (75+ miles away or more) without car
- Low Mileage Driver (8,000 miles per year or less)
Life Changes that impact Auto Insurance (check those that may apply to you or members of your household)
- Recently paid off a loan or lease for one of your cars
- Have (or will have) a teen driver
- Changed jobs or retired
- Drive for work, such as Real Estate Agent, Uber, or Pizza Delivery
Please tell us about any other changes in your household since last policy renewal if any, or any other applicable notes that may help us determine the proper limits of coverage for your auto and/or home insurance policies

Valencia 1074 Pittsburgh Road Valencia, PA 16059
Phone: (724) 898-2886
Email: mail@PAinsurancebrokers.com

New Castle - Butler 1214 Butler Ave New Castle, PA 16101
Phone: (724) 654-1411
Email: mail@PAinsurancebrokers.com

New Castle - Wilmington 2307 Wilmington Road New Castle, PA 16105
Phone: 724-652-8100
Email: mail@PAinsurancebrokers.com

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