Reliable coverage. Clear guidance. Real Support.

Thank you for allowing us to be of service over the last year!

We believe insurance should feel straightforward and personal, not overwhelming.

To get working on your personal insurance renewal, please complete the questionnaire below that allows to collect the renewal information that will allow us to put the most competitive option in front of you.

We look forward to continue being of service!

Let's get started

Personal Insurance Renewal Questionnaire

"*" indicates required fields

Let's Review the Basics

Name*

Enter the name listed first on your insurance policies

First Last

Please confirm your best email.*

This is the email we send policy notifications to.

Is this your best phone number?*

Check if applicable:

Spanish speaker only

Preferred Contact Method*

Have there been any changes to the following characteristics in your profile:*

Please check all that apply

Change in Martial status

Change in address

Change in occupation

Change in driving distance to/from work

Change in drivers in the household

None of the above

What is your new occupation?*

What is your new martial status*

Married

Single

Divorced

Domestic Partnership

What's your spouse/partner's full name?*

Spouse/Partner's date of birth*

MM slash DD slash YYYY

What is the new address:*

Street Address City State ZIP Code

Policies CURRENTLY have with Leal Insurance Services?*

Personal Auto

Homeowners

Landlord

Flood

Renters

Stand Alone (Texas Windstorm)

Personal Umbrella

Watercraft

Recreational Vehicle / Travel Trailer

Motorcycle / ATV / UTV / Golf Cart

Personal Auto

Have there been any changes to any of the following since the start of your last auto policy term:*

Please select all that apply

Change in driver status

Need to add a driver

Need to remove a driver

None of the above

Change/Add/Remove Driver*

You can list additional drivers by selecting the blue "+" on the right hand side of the row.

Full name of Driver

DOB

TXDL#

Change/Add/Remove

Have there been any changes to any of the following since the start of your last auto policy term:*

Change in vehicle usage (commute, pleasure, business use, etc)

Remove a vehicle

Add a vehicle

Lienholder change

None of the above

Change/Add/Remove Vehicle*

You can list additional vehicles by selecting the blue "+" on the right hand side of the row.

Year/Make/Model

VIN

Approx Annual Miles driven

Adding/Removing/Changing Usage

Lienholder to be updated:*

Have you added any custom parts or equipment over $1000 such as lifts, bumpers, tires, etc?*

Yes

Parts or Equipment added and value:*

Are any vehicles on the policy used for transportation for hire, such as Uber or Lyft?*

Yes

Please list the vehicle(s) used for Rideshare*

Our clients save 18% annually when completing carrier telematics generally within 90 days. Are you interested? By the way, you can opt out so don't be nervous.

Yes

Insureds who pay in full can save up to 10%. Are you interested?

Yes

Are you open to increasing your deductibles to save money?

Yes

Do you have any additional questions, concerns, or feedback regarding your auto insurance policy?

Yes

Please Describe your Questions, Concerns, or Provide Any Feedback.

Homeowners

Has your mortgage been sold or being serviced by a different company since your current policy term started?*

Yes

New Mortgage and Loan number:*

Any home updates or improvements?*

Have there been any additions or updates to your home? Ex have you added a: pool, solar panels, remodeling, additions, updates to the water, heating, plumbing, electrical or roof

Yes

If Yes, Please provide a value and description for all improvements

What year was your roof last replaced?

It's imperative to have the roof age when addressing carrier appetite.

Do you have central monitoring system such as ADT, VIVINT, Etc.*

A certificate WILL BE REQUIRED.

Yes

Monitoring company:*

Are you participating in a home sharing program such as AirBNB, VRBO, Etc?*

Do you rent your home as part of a home-sharing or short term renting program like AirBnb, VRBO or other?

Yes

Do you have any pets?*

Yes

Please describe the number, type, and breed of pets (if dogs)*

Do want to consider increasing your deductibles to save money?

Higher deductibles have lower premiums. Higher deductibles also means more money our of YOUR pocket in the event of a claim.

Yes, let's talk about other deductible options.

No, I'm not comfortable increasing my deductible in the event of a claim.

Remarket Acknowledgement*

Most insurance carriers are now requiring exterior property inspections (on very rate occasions an interior inspection will be required, but we will advise if that's the case) so we want to make sure we're crystal clear on the exterior inspection expectations.

The carrier will have a 3rd party inspector come to the property about 30 days after the policy starts. They will be looking at the overall condition to include but not limited to:

Branches/limbs/trees overhanging the roof line.
Roof conditions such as granular loss, lifting, curling, missing shingles, etc.
Cracks in your driveway or other concrete paths to your house.
Exterior siding conditions such as peeling paint, missing siding, holes in siding
Fence issues such as missing planks, falling, rotten, etc.
Debris in the yard

The carrier will require you to acknowledge and repair any of the issues reflected on the inspection report. Please discuss any questions with the agent assigned to your renewal journey.

By checking this box, you are acknowledging paragraph above.

Do you have any additional questions, concerns, or feedback regarding your home insurance policy?

Yes

Please Describe your Questions, Concerns, or Provide Any Feedback.*

Landlord / Rental Property

Has there been any change to your loan servicer or mortgage company?

Yes

New Mortgage and Loan number:*

Any home updates or improvements?*

Have there been any additions or updates to your home? Ex pool, solar panels, remodeling, additions, updates to the water, heating, plumbing, electrical or roof

Yes

If Yes, Please provide a value and description for all improvements*

What year was your roof last replaced?*

It's imperative to have the roof age when addressing carrier appetite.

Home Sharing*

Do you rent your home as part of a home-sharing or short term renting program like AirBnb, VRBO or other?

Yes

Are you open to increasing your deductibles to save money?

Higher deductibles have lower premiums. Higher deductibles also means more money our of YOUR pocket in the event of a claim.

Yes, let's talk about other deductible options.

No, I'm not comfortable increasing my deductible in the event of a claim.

Remarket Acknowledgement*

By checking this box, you are acknowledging paragraph above.

Personal Umbrella Policy

In the last year, any significant changes to your net worth that may require an adjustment in your personal umbrella policy coverage limits?*

Yes

If yes, please explain:

In the last year, have you purchased any property that may require an adjustment in your personal umbrella policy coverage limits?*

Yes

What are the addresses to be added and primary use?

Have you added or changed any recreational vehicles, boats, or other toys that might warrant additional liability coverage under your personal umbrella policy?*

Yes

If yes, please list:

Any changes in your household, such as new drivers, family members moving in or out, or changes in employment status, that could affect your personal umbrella policy coverage?*

Yes

If yes, please explain:

Watercraft Policy

Have you made any modifications or purchased new equipment for your watercraft in the past year that may require an update to your policy?

Yes

If yes, please explain to include value:*

Has your watercraft usage changed, such as frequency of use, different bodies of water, or participating in new activities (e.g., water sports, fishing, or chartering), which may impact your policy?*

Yes

If yes, please explain:

Have there been any changes to the storage or mooring location of your watercraft, or have you transported your boat to new locations that might affect your watercraft policy?*

Yes

If yes, please explain:

RV / Travel Trailer

Have you made any upgrades or purchased new accessories for your RV or travel trailer in the past year that may require updates to your insurance policy?*

Yes

If yes, please explain to include value:

Has there been a change in frequency of use such as taking longer trips, participating in new activities, or riding in different locations, that could affect your insurance policy coverage?*

Yes

If yes, please explain:

Are you renting your RV or Travel Travel to others?*

Yes

Are you using a program such as RVshare or Outdoorsy?*

Yes

Motorcycle / ATV / UTV / Golf Cart

Have you made any upgrades or purchased new accessories for your motorcycle, ATV/UTV or Golf Cart in the past year that may require updates to your insurance policy?*

Yes

Please explain:

Finally...

What policies do you have OUTSIDE of Leal Insurance Services that you would consider consolidating with our office:*

Please check all that apply

Auto

Homeowners

Rental Property(ies)

Personal Umbrella

Renters

RV or Travel Trailer

Flood

Watercraft

Motorcycle or ATV

Farm or Ranch

Business/Commercial

None at this time

Personal Auto

Who your current auto insurance carrier?

How much are you paying monthly from your auto insurance?

What kind of vehicles do you have and intended use?

Year, make, and model and intended use?

Who are the household members of driving age?

Name and date of birth

Landlord / Rental Property

How many rental properties do you own?

Addresses of all rental properties:

Please list your rental property carrier's name here:

Do you use this property for short term rentals such as AirBNB or VRBO

Yes

Do you require the tenants to have tenant insurance?

Yes

Are the property(ies) professionally managed?

Yes

Homeowners

Who's your current home insurance carrier:

What's your current home insurance premium:

When was your roof last replaced?

Newer roofs create discounts and increase carrier appetite.

RV / Travel Trailer

Who's your current RV / Travel Trailer insurance carrier:

Please insert your RV / Travel Trailer carrier's name here:

What kind of RV/Travel Trailer do you have?

Year, make, and model

Do you rent your RV / Travel Trailer to others?

Yes

Do you use a rental program such as RVShare or Outdoorsy?

Yes

How much are you paying monthly?

Watercraft

Who's your current watercraft / boat insurance carrier?

What kind of watercraft do you have?

Year, make, and model

How much are you paying monthly?

Motorcycle / ATV / UTV / Golf Cart

Who is your current Motorcycle / ATV / UTV / Golf cart insurance provider?*

What kind of Motorcylce / ATV / UTV do you have?

Year, make, and model

How much are you paying monthly?

Business / Commercial

What kind of business do you own?

Notes / Feedback for the Agent

Upload any supporting docs you need for us to review on policies you want to move over to us

Drop files here or

Max. file size: 5 MB, Max. files: 5.

Consent*

We're relying on the information you provide to make any adjustments needed to your current policy, coverages, limits, etc. Renewal coverage is not guaranteed and if your current doesn't offer a renewal, we will work diligently to find a replacement policy for you. You agree that the application information is true and correct to the best of my knowledge.

By submitting this request you are authorizing Leal Insurance Services, its affiliates and carrier
partners the access to pull the necessary reports (i.e. claims, credit, and loss history) to confirm the data submitted.

Submitting your quote request does not constitute a binding confirmation of a new or revised insurance coverage.

Leal Insurance Services is committed to respecting your privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you through phone, text and email as needed.

You may opt-out of all future communication at any time by making your preferences known to us.

I consent and agree.

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