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Account Review

Fountainhead Insurance is here to review your current account to ensure you're properly covered.

Account ReviewGravity Certs2024-11-25T18:34:57-04:00
Name(Required)
A thorough review includes completing each of the sections listed below. If anything does not apply to you, please uncheck the box(es).

Home Review

Let's start with your home.
Did you install an Alarm System in the last 12 months?
Which components are included in your alarm system?
Check all that apply.
Is your home owned in a Trust, LLC, or other legal entity?
Any updates, renovations, additions planned or recently completed?
Have you updated any of these?
Does your home have solar panels?
How is the solar power being used?
Check all that apply.
Where are the solar panels located?
Check all that apply.
Do you own or lease the solar panels?
Are you responsible for insuring the panels?
Has the occupancy status of your home changed?
How has your home occupancy changed?
Does your home have an underground oil tank?
Would you like to discuss getting Flood Insurance or increasing your flood insurance limits?
Would you like to get, or increase, fungi or mold coverage?
Would you like to get, or increase, coverage for personal Cyber protection?
Any business conducted at your home?
What risk management strategies do you use at this home?
Check all that apply.

Secondary Home Review

Let's review another home.
Example: Florida Home
Did you install an Alarm System in this home in the last 12 months?
Which components are included in this alarm system?
Check all that apply.
Is this home owned in a Trust, LLC, or other legal entity?
Any updates, renovation, or additions planned or completed for this home?
Have you updated any of these on this home?
Does this home have solar panels?
How is solar power used?
Check all that apply.
Where are solar panels located?
Check all that apply.
Own or lease the solar panels?
Responsible for insuring the panels?
Has the occupancy status of this home changed?
How has this home occupancy changed?
Does this home have an underground oil tank?
Would you like to discuss getting Flood Insurance or increasing your flood insurance?
Would you like to get, or increase, fungi or mold coverage?
Would you like to get, or increase, coverage for personal Cyber protection?
Any business conducted at this home?
What risk management strategies do you use at this home?
Check all that apply.

Valuable Articles Review

Let's review your valuable articles coverage.
Any significant acquisitions in the last 12 months we should know about such as
Please provide a brief description of item(s) purchased or aquired
Click the plus icon (+) to the right to add multiple items.
Item Description
Value ($)
 
Do you have an appraisal for any of your valuables?
Drop files here or
Max. file size: 1 MB.
    Are any valuable items stored in a bank vault?
    What risk management strategies do you use to protect your valuables?
    Are any valuables owned in a Trust or LLC?
    Example: Loaning to a museum, or repairs being done.

    Automobile Review

    Let's review your automobile coverage.
    Have you purchased any vehicles in the past 12 months?

    Vehicle 1

    2. Add Vehicle

    Vehicle 2

    3. Add Vehicle

    Vehicle 3

    4. Add Vehicle

    Vehicle 4

    5. Add Vehicle

    Vehicle 5

    Have you sold or turned in any vehicles in the past 12 months?
    Any new drivers to be added to your policy?

    Driver 1

    1. Driver Name
    1. Date of Birth
    2. Add Driver

    Driver 2

    2. Driver Name
    2. Date of Birth
    3. Add Driver

    Driver 3

    3. Driver Name
    3. Date of Birth

    Any drivers away at school without a car?
    Please enter name of student and location of school
    Click the plus icon (+) to the right to add multiple students.
    Student Name
    School Name
    School City & State
     
    Have you paid off any car loans?
    Include Year, Make, Model of each vehicle.
    Any vehicles used for business purposes?
    Including ride sharing services such as Uber and Lyft.
    Please briefly describe the car and the business
    Click the plus icon (+) to the right to add multiple vehicles.
    Vehicle
    Business Description
     

    Liability Review

    Let's review your liability exposures.
    What is your approximate net worth?
    Tell us about your liability risks
    Select all that apply.

    Wrapping Up

    Would you like to discuss any other topics?
    Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
    Consumer Disclusure(Required)
    By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
    This field is for validation purposes and should be left unchanged.

    Get Insurance

    Our knowledgable agents are experts at finding the right coverage for your family or business. Get your insurance quote now.

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    Miami, Florida 33156

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    San Juan, Puerto Rico 00920

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    DISCLAIMER: Informational statements regarding insurance coverage are for general description purposes only. These statements do not amend, modify or supplement any insurance policy. Read your policy or consult with your agent for details. Your eligibility for particular products and services is subject to final underwriting and acceptance by the insurance company providing such products or services.

    This website does not make any representations that coverage does or does not exist for any particular claim or loss, or type of claim or loss, under any policy. Be sure to read the policy, including all endorsements, or prospectus, if applicable.

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    Fraud is a crime

    If your application contains purposefully misleading, absent, or inaccurate information, you could be charged with fraud. Your insurance carrier could potentially void your policy, or you could face civil or criminal charges or penalties.

    Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime.

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