Insurance rates and coverage needs change often. If you're a current client of Eden Insurance and are looking to get re-quoted, please fill in this information of your current coverage so that we can re-shop your policies. Your full name* Your primary address* Phone number* Email address* How many people in your household?* Current occupations for each household member, if applicable. Are you looking for a new quote on Auto, Home or Renter's? AutoHomeRenter's How many vehicles do you currently have with us? 12345 How many miles per year do you put on each car? Who is the primary driver for each vehicle? Do any of these vehicles have blind spot detection? If so, which one(s)? When were your vehicle(s) purchased? (Please include month and year) Car 1: Car 2: Car 3: Car 4: Car 5: Is this vehicle used for Uber / Lyft? (If not, please leave this field blank) Is there anything new on anyone's driving record? YesNo What has changed on the driving record? Do you have any new drivers you are adding? YesNo If so, please provide the following information: New Driver's Name New Driver's Date of Birth New Driver's License # Are you adding any new vehicles? YesNo Please provide the following information for the new vehicles. Year & Make Model VIN Loan or leasing company? YesNo If yes, what is the name of the company? What is their mailing address? Would you be willing to do a tracking device or mobile app to earn extra discounts for safe driving? YesNo Do any of your vehicles have a hitch? YesNo Comments or additional relevant information? What is the deck size (if applicable) What is the porch size (if applicable) Do you have a fenced yard? YesNo Do you have a trampoline? If yes, is it netted? What percentage of your basement is finished? (If any) Do you have a pool? YesNo Above ground, or in ground? Cost for a new pool? How many full baths? How many half baths? Do you have an alarm? YesNo What kind of alarm do you have? FireBurglarBoth Is it central reporting? YesNoI don't know Do you have a wood-burning stove? (If so, is it professional installed?) Are there any additional features or changes we didn't cover? (e.g. Jacuzzi tubs, skylights, additional rooms, etc.) Do you have any smart home devices? (If so, what?) Do you have a sump pump? YesNoI don't know Do you have a backup system? YesNo Is it water, battery, or generator backup? WaterBatteryGeneratorNone Do you have any dogs? (if so, what breed?) Any heating devices in your garage or detached structures? If so, what kind? When were the following updated (if at all?) Roof: Plumbing: Electrical: Heating: Cooling: Water heater: Do you want any of the following coverages? Water backupEarthquakeMine subsidenceScheduled items Would you like to look at a different home deductible? YesNo Any current issues with the home? (siding, roof, windows, tree limbs too close, major foundation cracks, etc.) Do you run an in-home business? (If yes, what kind?) Any questions or comments we did not cover? How much personal property coverage do you need? Deductible you'd like quoted for? Do you want any items scheduled? Do you want water backup coverage? YesNo Number of units between firewalls in your building? Is there a sprinkler system? YesNo Any dogs? If so, what kind? Any comments?