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Personal Lines Questionnaire

Questionnaire

Highpoint Private Client has exclusive access to sophisticated property and liability insurance products giving us the ability to tailor custom solutions for your complex needs

Step 1 of 3

33%

Today's Date:
Need By:
Named Insured:
First Last
Additional Insured(s):
Referred By:
Mailing Address
Street Address Address Line 2 City State ZIP Code
Prior Address (if less than 3 years):
Street Address Address Line 2 City State ZIP Code
Property Address:
Street Address Address Line 2 City State ZIP Code
Email Address:
Cell Phone:
Work Phone:
Named Insured DOB:
Month
Day
Year
Additional Named Insured DOB:
Month
Day
Year
SS#:
SS#:
Occupation/Employer:
Occupation/Employer:

Property Purchase /Closing Date:
Month
Day
Year
Property Purchase Price:
Property Square Footage:
Property Type (Select Below):
- Primary (enter yr. built below)
- Rental Property
If Rental Property (check all that apply):
- Short Term
- Long Term
- Property Management Company
Property Renovations:
- Wiring
- Plumbing
- Re-Roof
- Other
Property Contents (check all that apply):
- Pool
- Fence (around pool)
- Alarm System
- Animals
- Drone
- Diving Board
- Trampoline
- Alarm Certificate
- Home Business
Do you need to schedule jewelry, art, guns, items of value?
- Yes
- No
Do you own off-road vehicles or watercraft (boats, jet ski, ATV's, golf carts, dirt bikes, etc)?
- Yes
- No
Do you need excess liability?
- Yes
- No

Auto Coverage - Driver Name:
Auto Coverage - Drivers License #:
Vehicle Information (Year/Make/Model):
Vehicle ID #:
Usage (P) or (W):
Annual Mileage:
Lien Holder's Name:
First Last
Lien Holder's Address
Street Address Address Line 2 City State ZIP Code
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.

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Highpoint Insurance Group offers comprehensive insurance solutions in Friendswood, TX, the Greater Houston area, the Texas Hill Country, and across the United States.

The next step is easy, call 281-204-8770 Or, Contact Us

Our Locations

Corporate Office
4300 FM 2351
Friendswood, TX 77546

Hill Country
602 Steve Hawkins Pkwy
Marble Falls, TX 78654

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call 281-204-8770
fax 281-204-8810

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Email Address*
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This field is for validation purposes and should be left unchanged.

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Who We Are
Media
- Blog
- Podcast
- Webinars
Our Services
Client Tools
Pay Bill
Report Claim

Contact Us
Call 281-204-8770

Visit Highpoint Insurance Group on Facebook
Visit Highpoint Insurance Group on Linkedin
Visit Highpoint Insurance Group on Youtube
Visit Highpoint Insurance Group on Instagram
Visit Highpoint Insurance Group on Phone
Visit Highpoint Insurance Group on Email

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