Insurance Review Checklist – Your Auto Policy | Augustyniak Insurance Group in Jacksonville, Florida

Personal Information

Name ✶

Address ✶

Home Phone ✶

Mobile Phone

Email ✶

Preferred Method of Contact ✶

Auto Insurance Company ✶

When you think about insurance, what is most important to you? ✶

Coverage

Service

Price

Insurance Review Checklist – Your Auto Policy

Insurance companies offer automatic payment plans through a credit card or checking account. Would you like to be set up with an automatic payment plan? ✶

Yes

Many insurance companies offer online access or mobile access for policy information. Would you like help in setting this up? ✶

Yes

I already have online or mobile access to my policies.

Do you have any children away at college that are still members of your household? ✶

Yes, but they do not have a car with them

Yes, and they have a car with them

Are all the vehicles on this auto insurance policy titled to you or your spouse? ✶

Yes

Who are the cars titled to?

Does this policy list all of the drivers in the household or that have regular access to your cars? ✶

Yes

Name of Driver to add

Are any vehicles used for business (ex. Sales calls, delivery of goods, contractors, realtors, signs on the car)? ✶

Yes

Which car(s) is used?

Describe how you use it?

Do you want to increase the deductible(s) on your cars to lower your premium? ✶

Yes

Do any drivers qualify for Good Student Discount – fulltime student under 22 years with a 3.0 GPA or better? ✶

Yes

Which driver?

Do you have any children with a learner’s permit? ✶

Yes

Which child?

Do you or a member of your household use any vehicle to drive for UBER or other ride sharing services? ✶

Yes

Rental Car Reimbursement coverage pays to rent you a car while yours is being repaired after a claim. Do you want to add or change your Rental Reimbursement coverage? ✶

Yes

How much would you need to rent a replacement car per day?

Have any vehicles been customized or altered? ✶

Yes - your policy may need special coverage for non-factory parts. Please call us to discuss

Do you or your household members own any classic cars, Motorcycles, RV, or Golf Carts? ✶

Yes, and they are insured on this policy

Yes, and they are insured elsewhere

What company insures them?

If you don’t have medical insurance or have high medical insurance deductibles, you may want to purchase medical payments on your auto insurance. Would you like a quote? ✶

Yes

80% of people think life insurance is more expensive that it actually is. Would you like a quote for life insurance for you or a family member? ✶

Yes

How much auto insurance coverage do you recommend?

Many people think of auto insurance as only covering damage to the car. Auto insurance can also cover you for being sued as a result of causing an accident, or for injuries you sustain during an auto accident. We recommend that you should purchase insurance limits high enough to protect your assets and income. Specifically, we recommend that you purchase:

Bodily Injury (BI) /Property Damage (PD) liability limit limits high enough to protect your assets
Stacked uninsured motorist coverage equal to your Bodily Injury Liability coverage.
If your household earns more than $100,000 a year or has more than $250,000 in assets, purchase an umbrella policy. Umbrella policies are very affordable. A $1million umbrella policy typically costs $200-$450/year.

I have read the above section “How Much Auto Insurance Coverage Do You Recommend” ✶

I agree

Would you like to review your current liability or uninsured motorist coverage with us? ✶

Yes

Do you want a quote for an Umbrella Policy? ✶

Yes

Do you have any questions or comments about your policy?

To help us coordinate your insurance protection, select any policies you have that are not insured with this agency.

Policies Not Insured With Us

Auto

Home, Renters, Condo

Rental Properties

Boat, Jet-ski, Yacht

Motorcycle, Golf Cart, ATV

RV, Camper

Jewelry, Art

Life Insurance

Flood

Umbrella/Excess Liability

Business Insurance

Workers Compensation

Agency Feedback

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Insurance Review Checklist – Your Auto Policy

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Auto Policy Review

Personal Information

Insurance Review Checklist – Your Auto Policy

How much auto insurance coverage do you recommend?

To help us coordinate your insurance protection, select any policies you have that are not insured with this agency.

Agency Feedback

The biggest compliment that you can give us is to refer a friend. If you send us a referral, we'll send you a $10 Publix Gift Card as a thank you.

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