Online Insurance Review Form



I hope all is well with you and your family in these trying economic times. Even in good times, having a review of your current insurance program to make sure coverage are in line with your goals and life changes is a prudent step. I would like to schedule a meeting with you to review your current insurance situation.


Customer Name:


Over the past couple of years, I have come across some value-added products that may be of interest to you. I have personally used many of these and can provide you with valuable information to make an informed decision that benefits you and your family.


Please check areas that may be of interest when we meet:
Life Insurance
Accelerated Mortgage Payoff
Disability Income Insurance
Business Insurance including Worker’s Compensation
Health Insurance
Investment Planning
Long-term Care Insurance
Child Education Funding
Legal Protection
College Planning Education
Identity Theft Protection
Tax Preparation
Wills/Health Directive Info
Accounting Service
Debt Elimination/Equity Acceleration
Jewelry or Expensive Collections to Schedule on Home Policy


Changes—in the next year I plan to:
Graduate
Child Starts Driving
Buy Property
Make a Major Purchase
Get Married
Child Graduates
Sell Property
Retire
Buy a Home
Change Jobs
Sell Business
Have a child
Start a Business


Please update the following information for our files—Names of
all family members and their birthdays:









Address:

City:

Zip Code:



Wedding Anniversary Date:


Email Address:


Notes: