Personal Insurance Renewal Review

1 Contact Info

2 Property Info

3 Wrap-Up Info

Are you a current client of RiskWell?*
What effective date do you want for your new insurance?*
Date Format: MM slash DD slash YYYY
Your Name*
First Last
Your Date Of Birth*
Date Format: MM slash DD slash YYYY
Is the property held in your personal name or another legal entity (LLC, etc...)*
Entity Name*
Your Email*
Your Phone Number*
Your Mailing Address*
Street Address Address Line 2 City State ZIP Code

Property address to be quoted:*
If you need a quote for more than one property right now, we will gather that information on your Discovery Call.

Street Address Address Line 2 City State ZIP Code
Property County
What's your plan for this property?*
Full name and mailing address for underlying seller*
Building Type*
Is there a lender or mortgagee for this property?*
Full Lienholder/Mortgagee Clause*
Include the full name and mailing address. If you don't know it, just put "TBD" and we'll get it from you later.
Coverage Amount Needed ($)*
For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.
How will this policy be paid for?*

Do you need a companion FLOOD INSURANCE quote for this property?*
How did you first hear about RiskWell?
- Personal Referral
- Google Search
- McKinney Chamber of Commerce
- Local event
- Facebook Group/Post
- YouTube video
- Word of mouth
Who referred you to us?*
Our team is also well equipped to help with your personal insurance needs (Home & Auto Insurance + whatever else you need.) After we're done with delivering this real estate quote, can we review your personal insurance options?*
Date to contact you about reviewing your personal insurance
Please select the future date you want us to contact you on, so we can perform a full review of your personal insurance options.
Date Format: MM slash DD slash YYYY
What else do we need to know to deliver you an outstanding experience?
Please upload all relevant documents here:
Drop files here or
Communication Consent*
RiskWell is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text and email as needed.

You may opt-out of all future communication at any time by making your preferences known to us.

RiskWell operates by the simple rule of "treat other people the way you want to be treated."
I authorize RiskWell to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..

First Name	Last Name	Date Of Birth	Driver's License #

Year	Make	Model	Vehicle ID # (VIN)