Annual Insurance Review

What is the best way to contact you?

We want to be sure we are meeting all of your insurance needs and providing you with the peace of mind you deserve.

Upon completion of this form, your agent will contact you to:

  • Evaluate your insurance policies and verify that your most valuable assets are adequately protected.
  • Answer your questions you have about your coverages and identify any discounts you may be eligible for

Auto Insurance

Do any of your licensed children qualify for the good student discount (grade B or above)?
Have you purchased or sold a vehicle lately that needs to be added or removed from your policy?
Do we insure all of the vehicles you own?
Do you have any children away at school?
Do you have another car to use if your car needs to be repaired because of a claim?
Have you added any equipment other than the manufactured-installed items to your vehicle?
Have you recently purchased any of the following miscellaneous vehicles? (please check all that apply)

Home Insurance

Does your home have any new additions, remodeling projects, or updates? (i.e. new roofing or siding)
Are there valuables in your basement that need protection from water damage?
Is there any type of business being conducted from your home (i.e. Mary Kay, Avon, etc.)?
Have you recently purchased any of the following? (please check all that apply)


Are you interested in coverage that protects you against identity theft?
Are you interested in an umbrella policy that protects your family and assets against large personal liability lawsuits?
Are you interested in reviewing life insurance policies? (You may qualify for a life discount)
Are you interested in an annuity saving plan (i.e. IRA, Roth)?
Are you interested in changing your deductible to possibly save money?
Are you interested in a hassle-free electronic payment option for your insurance bill?


How satisfied are you with your insurance experience with Prairieland Insurance Group, LLC?

Thank you for taking the time to complete your annual insurance check-up!

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