On this page, you will find our Homeowners Survey. Completion of this survey allows our agency staff to ensure that your homeowner policy covers potential losses or to make recommendations for proper coverage. Thank you for your response. Homeowners Survey (Required fields are bold) First Name Last Name Address Address (continued) City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip E-mail Address Phone Have you made any recent additions, remodeling or added any new exterior structures such as gazebo or swimming pool that would have increased the value of your home? Yes   No Is any property held in a trust? Yes    No Are you a member of a homeowner or condominium owner association? Yes    No The standard homeowner policy identifies specific dollar limits for some personal property lost as a result of theft. Other items have specific limits regardless of the cause of loss. These items include jewelry, furs, firearms, watercraft, antiques, and silverware to name a few. Do you have any items that might be more appropriately insured by scheduling them on your policy? Yes    No Do you use independent contractors (businesses) for landscaping or lawn mowing, housekeeping, etc.? Yes    No Do you own other properties such as rental properties, vacant land or farmland? Yes    No Do you perform incidental duties for any organization (school, religious, charitable) or serve as a member of board for any organizations? Yes    No Do you participate in any business from your home, or have any hobbies become “money-making” activities? Some examples include: crafts, sewing/alterations, income tax preparation, tutoring, Pampered Chef or similar home ware product sales. Yes    No Do you keep “business” property at your premises? Yes    No Any relative(s) now residing in a long-term rehabilitation or nursing facility? Yes    No     I would like to receive e-News from Marion Insurance Agency as it is made available. Marion Insurance Agency limits the number of e-mails sent quarterly and your e-mail address will not be shared. You can easily unsubscribe by e-mailing info@marion-insurance.com

disclaimer    •   privacy policy   •    contact us   •    faq ©2004  Marion Insurance Agency • 605 East Center St • Marion, OH 43302 designed/hosted by Lunara Solutions, LLC