Umbrella Quote Request - HH Insurance

Are you a New or Existing Client?*

New Client
Existing Client
AnswerLink

Please Provide Salesforce Account URL*

Name of Caller

Contact Information on File is Current*

Yes
No

Phone*

Email*

Mailing Address on File is Current*

Yes
No

Personal Information

How many properties are owned?

How many properties are under an LLC Name?

1st Property Details

1st Property Details*

Address	Occupancy (Primary, Secondary, etc.)	Pets

Swimming Pool? - 1st Property*

If yes, is swimming pool fenced? - 1st Property*

Trampoline- 1st Property*

Current Liability Limits - 1st Property*

Current Homeowners Insurance Company - 1st Property*

2nd Property Details

2nd Property Details*

Address	Occupancy	Pets

Swimming Pool? - 2nd Property*

If yes, is swimming pool fenced? - 2nd Property*

Trampoline- 2nd Property*

Current Liability Limits - 2nd Property*

Current Homeowners Insurance Company - 2nd Property*

3rd Property Details

3rd Property Details*

Address	Occupancy	Pets

Swimming Pool? - 3rd Property*

If yes, is swimming pool fenced? - 3rd Property*

Trampoline- 3rd Property*

Current Liability Limits - 3rd Property*

Current Homeowners Insurance Company - 3rd Property*

4th Property Details

4th Property Details*

Address	Occupancy	Pets

Swimming Pool? - 4th Property*

If yes, is swimming pool fenced? - 4th Property*

Trampoline- 4th Property*

Current Liability Limits - 4th Property*

Current Homeowners Insurance Company - 4th Property*

5th Property Details

5th Property Details*

Address	Occupancy	Pets

Swimming Pool? - 5th Property*

If yes, is swimming pool fenced? - 5th Property*

Trampoline- 5th Property*

Current Liability Limits - 5th Property*

Current Homeowners Insurance Company - 5th Property*

Vehicle Information

How Many Vehicles Owned?*

Liability Limits on 1st Vehicle

Liability Limits on 2nd Vehicle

Liability Limits on 3rd Vehicle

Liability Limits on 4th Vehicle

Liability Limits on 5th Vehicle

Number of Registered Classic Cars

Boat Information

Number of Boats of Personal Watercraft/Jetskis

Length of 1st Boat/Watercraft

Horsepower of 1st Boat/Watercraft

Length of 2nd Boat/Watercraft

Horsepower of 2nd Boat/Watercraft

Length of 3rd Boat/Watercraft

Horsepower of 3rd Boat/Watercraft

Length of 4th Boat/Watercraft

Horsepower of 4th Boat/Watercraft

Length of 5th Boat/Watercraft

Horsepower of 5th Boat/Watercraft

Household Members

Number of Household Members

1st Household Member

Name	DOB	Drivers License #	Occupation	Highest Education Level

2nd Household Member

Name	DOB	Drivers License #	Occupation	Highest Education Level

3rd Household Member

Name	DOB	Drivers License #	Occupation	Highest Education Level

4th Household Member

Name	DOB	Drivers License #	Occupation	Highest Education Level

5th Household Member

Name	DOB	Drivers License #	Occupation	Highest Education Level

6th Household Member

Name	DOB	Drivers License #	Occupation	Highest Education Level

Any prior claims?

Yes
No

Please describe prior claims

Be sure to include any relevant information.

Request ALL Current Declarations:*

We will need copies of all

Client will Email or text pdf documents to sales@hhinsgroup.com
Client will send photo of documents via email or text to sales@hhinsgroup.com
Client will fax documents to HH service fax number (727)601-0988
Client will mail documents to HH home office 9887 4th St N # 200, St. Petersburg, FL 33702
Client denied request for declarations page and team member reassured client dec is for apples-to-apples coverage comparison.

Have you worked with HH Insurance in the past?

Yes
No

How did you hear about us?*

Other - How did you hear about us?*

Who's your realtor? (First & Last Name)

Who's your lender? (First & Last Name)

Who's your friend or relative?

Who's the HH Employee?

Who's the Financial Advisor/Estate Planner? (First & Last Name)

Quote Request Taken By*

Notes / Additional Remarks

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