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Ramsburg Family Insurance Review


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

First Name
Required
Last Name
Required
Social Security Number
Optional
E-Mail Address
Required
E-Mail Address
Required
Home Phone Number
Required
Work Number
Optional
Cell Phone Number
Optional
Occupation
Optional
Highest Level of Education
Optional
ZIP / Postal Code
Required
Number of Household Residents
Optional
Spouse Name
Optional
Spouse Email
Optional
Work Number
Optional
Cell Phone Number
Optional
Occupation
Optional
Preferred method of contact
Optional



Homeowners Coverage
Have you or are you planning on investing $15,000 or more in renovating your home? (Interior or exterior)
Optional

If yes, projected or finished date of renovation.
Optional
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Please provide approximate years of updates or repairs to the following:
Plumbing System
Required
Type of Plumbing
Optional
Type of Fuel
Optional
Electrical System
Required
Roofing
Required
Roof
Required
Exterior
Optional
Do you have any supplemental heat such as a wood, coal, pellet or gas stove?
Optional

Does your home have a security system?
Optional

Is your basement Finshed ?
Optional

If Yes, Approximate value of the finished area
Optional
Do you have a sump pump?
Required

If yes, Do you have a water intrusion alarm or battery back up?
Optional

Do you have any structures on the property that are not attached to your home—such as a garage, pool house, cabana, gazebo, pergola, sports court, and outdoor living area (built in barbeque or rock/masonry seating areas)?
Required

Do you own any boats, jet skis, recreational vehicles, snowmobiles, ATV’s or golf carts?
Required

Do you own any items valued over $1,000? (i.e. Furs, Fine Arts, Guns , Coins, Other Collectible Items)
Required

Do you have professional tools or equipment on your premises for business use?
Required

Do you have a pool on your property?
Required

If yes, is it an In-ground or Above-ground pool?
Optional

Is the pool fenced or have a locking or removable ladder?
Optional

Do you have any pets?
Required

If Yes , What type of pet(s):
Optional
Do you have a ..... ?
Trampoline
Required

Skate Ramp
Optional

Tree House
Optional

Other Recreational Structure
Optional

Are any of your children attending school away from home?
Required

If yes, number of students attending school away from home:
Optional
On or off campus?
Optional

Do they have high value items with them at school?
Optional

Have you refinanced or paid off your home?
Required

Are any members of your household living in an assisted living facility?
Optional

Do you have a vacation home or 2nd residence?
Optional

Automobile Coverage
Have you acquired any new vehicles not listed on your policy?
Optional

Do you have a Company Car?
Optional

Do you car pool?
Optional

Do you own any Trailers?
Optional

Do you have any children attending school away from home that have a vehicle with them?
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If yes, please list child, college attending and which vehicle
Optional
Do you own any vehicles that are insured with another carrier that is not insured with our agency?
Optional

Important Concerns
Have you made any major lifestyle changes that might alter your insurance needs? Marrying, Divorcing or Retiring?
Optional

Have you changed the ownership structure on your property? (Started a Trust or an LLC?)
Optional

If you have Life Insurance, do you have enough coverage to pay off your home mortgage?
Optional

Do you have Long Term Disability Insurance to Protect you family if you were disabled?
Optional

Are you interested in protecting your retirement assets with Long Term Care Insurance?
Optional

Ask yourself, “How will my family manage financially if I die?” We have affordable insurance plans and life insurance rates have dropped significantly within the past few years.
Do you have the protection that your family will need to maintain their lifestyle or pay for college? When was the last time you had a financial check-up?
Additional Notes, Information & Instruction
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Date Submitted
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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