External : Personal Lines Diagnostic Questionnaire

(801) 505-5500

Get a Quote
Locations

Business Insurance
Personal Insurance
Client Support
- Carriers
- Contact Us
About

Your Personal Insurance Questionnaire

Step 1 of 6

Basic Information

First Named Insured(Required)

First Last

1st Named - Education

1st Named - Employment

Second Named Insured

First Last

2nd Named - Education

2nd Named - Employment

Primary Contact Person(Required)

Contact Person if not named insured

First Last

Primary Contact Phone(Required)

Primary Contact Email(Required)

Primary Contact Address(Required)

Street Address Address Line 2 City State ZIP Code

Background

How did they hear about GRIT Insurance?

Who do you have your insurance with now?

How long have they had your business?

Budget

What is your current budget for your personal Insurance?

What is your timeline for having us complete the market analysis for and present you with your options?

Would you be interested in insurance recommendations to add protection you didn't have now if added only 10-20% to your current insurance budget?

Yes

Do you have a business insurance you'd like us to talk about at another time?

Yes

Types of Personal Insurance Policies

I am interested in...

Auto

Home

Secondary Home

Rental Property

Recreational Vehicle (Boat, Motorcycle, ATV, etc)

Umbrella

Other

Other Policy Type

Auto Insurance Information

Current Auto Carrier

Current Agency/Carrier How Long

Auto Expiration Date

MM slash DD slash YYYY

Current Auto BI Limit

Current Auto Property Damage Limit

Household Drivers (+/- to add/remove)

First Name

Last Name

Date of Birth

Driver License #

Good Student Discount

Last Citation(s)

Good Student = Ages 16–25 with a GPA of 3.0 or higher.

Household Vehicles (+/- to add/remove)

Year

Make

Model

VIN

Driver

Use : Pleasure, Commute or Business

Homeowners Information

Current address less than 3 years

Yes

Own, Rent or Buying

Prior Address

Street Address Address Line 2 City State ZIP

Policy Type

Units in Building

Home Type

Current Home Carrier

Current Carrier How Long

Current Home Coverages

Dwelling

Separate Structures

Personal Property

Liability

Deductible

Wind Hail Deductible

Home Information

Year Built

Sq Ft

Roof Replace

Furnace Replace

Updates?

SQ FT above ground

Basement?

Yes

Basement SQ FT

Basement % Finished

Garage Type

# of Bathrooms

# of Fireplaces

Roof Type

Exterior Walls % of Each

Brick Veneer

Aluminum/Vinyl Siding

Stucco on Frame

Stone Veneer

Wood Siding

Other

Type of Electrical

Type of Plumbing

Type of HVAC

Alarm System

Yes

Sewer & Drain Coverage

Yes

Buried Utilities

Yes

Additional Features Add Value to the Property

Deck

Hot Tub

Pool

Central Vac

Patio Cover

Other

Are you interested in getting the following additional coverages for your home?

Earthquake Coverage

Flood Coverage

Interested in additional liability insurance coverage? (Umbrella)

$1,000,000

$2000,000

$3,000,000

$4,000,000

$5,000,000

Other home Information you would like us to know

Any additional comments or questions you may have for us

SAVE TIME, AGGRAVATION, AND MONEY

At no additional cost to you, we can work on your behalf to compare your current coverage with a wide range of insurance companies to see who has the best possible deal on your insurance.

Start Quotes

CONNECT WITH US

LOCATIONS

GRIT INSURANCE GROUP

5525 South 900 East Suite 345
Salt Lake City, UT 84117
(801) 505-5500
PARK CITY LOCATION

1245 Deer Valley Dr, Ste 300,
Park City, UT 84060
(801) 505-5500
CHALLIS LOCATION

401 main Ave
Challis, ID 83226
(208) 398-4450

GET IN TOUCH

Interested in working with GRIT Insurance?
Please contact us here or call our office.

We look forward to hearing from you!

OFFICE HOURS

Mon–Fri: 9AM–5PM
Saturday & Sunday: Closed

Disclaimer
Terms and Conditions
Privacy Policy