M - F, 7:00am - 6:00pm
(617) 389-9400

Discount Protection Survey

Discount Protection Survey
CLIENT INFORMATION
Email:

Cell Number:

Work#:

Occupation:

AGENCY CLIENT CODE
Cell#:

Email:

Work#:

Occupation:

AUTO PROTECTION QUESTIONS
Does our agency insure ALL of your household cars?:

Have you acquired any new vehicles not listed on your policy?:

Are all licensed drivers in your household listed on your policy?:

Are there any licensed drivers a student with a B or above average?:

Are there any licensed drivers who have taken a defensive driving course?:

Are there any licensed drivers away at school?:

Are there any hybrid or electric vehicles?:

Are any vehicles garaged at another location?:

Are there any non-household residents that normally drive your car?:

Are there any vehicles used in connection with a business?:

HOME PROTECTION QUESTIONS
Does our agency insure ALL of your properties/home?:

Do you have a pool?:

Does your home have a central burglar or fire alarm?:

Have you done any significant renovations or additions in the last 3 years?:

Do you have a Temperature Monitoring Device?:

Do you Winterize your plumbing? (Discount of secondary homes):

Do you service your Heating Unit annually? (Discount on secondary homes):

Do you have a Hard-Wired Generator permanently installed?:

Does your Sump Pump have a Battery Backup System?:

Do you have a Water Leak Detection and Control System?:

Does your home have a Lightening Rod Protection System?:

Do you have Hurricane Shutters?:

Do you have a Shatter Resistant or Hurricane Proof Windows?:

Do you run a business from your home?:

DO YOU OWN ANY OF THE FOLLOWING
Check all that apply
Any Collector Items
Art Work
ATV
Baseball Cards
Golf Carts
Golf Clubs
Guns
Jet Ski
Over $5,000 in Jewelry
Moped
Musical Instruments
Snowmobile
HOUSEHOLD UPDATES
What year was your heating and cooling system last updated?:

What year was your roof last replaced?:

What year was your plumbing replaced?:

What year was your electric last updated?:

GENERAL QUESTIONS
Do you have any specific questions on an area of insurance that we may research for you? Comments:

Do you have any suggestions on how we could improve the Agencys Service?:

Do you have any specific expectations or special requests we may work on for you?:

Other than price, what is most important to you when it comes to Insurance? Please select a number 1 through 4 (1 being the most important)
Agency Service:

Insurance Company:

Protection of Assets:

Claim Service:






Get a Quote
or call
617-389-9400

Find out more


Mailing Address


220 Broadway Suite #304
Lynnfield, MA 01940

BUSINESS HOURS


7:00am - 6:00pm

Everett Lobby Hours:
8:30am - 4:00pm

Lynnfield Lobby Hours:
8:30am - 5:00pm

Everett Office


629 Broadway
Everett, MA 02149
(View Map)

Lobby Hours:
8:30am - 4pm, M - F
Phone: 617-389-9400
Fax: 781-584-4445

Lynnfield Office


220 Broadway Suite #304
Lynnfield, MA 01940
(View Map)

Lobby Hours:
8:30am - 5pm, M - F
Phone: 781-596-0033
Fax: 781-584-4445
© Philbin Insurance Group, All Rights Reserved. DreamingCode, Inc.