Call us, come in and see us…or Schedule Online! Schedule Now Name First Last Your relationship with the Kim Hastings Agency:* Current Client Future Client Other HiddenReference ID:If you were provided a Reference ID, please enter it here. If not, leave blank.Address (if changed or you have more than one):* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Changes/Improvements to PropertyUpdates to PropertyMake sure to request all changes to your property become effective on the next renewal data. Making changes to your policy, even if a potential discount, may activate an annual rate increase that may have occurred between your last renewal date and the effective date of the change. New Roof New Plumbing New Electrical Monitored Alarm Service Other Policies to be ReviewedThe more policies you have with our agency, the less likely to have duplicate coverage...and may qualify for additional bundle discounts!What would you like us to review? Auto - Personal Auto - Business Primary Home Secondary Home Rental Property Commercial Property Life Insurance Annuity or Retirement Products College Funding SIMPLE or SEP - Business Retirement Flood Health Motorcycle or RV Potential Discounts to ConsiderSelect all that may apply. See Farmers Discounts Multi-Line Bundle Discount Signal by Farmers - Auto Safe Driving App Distant Student Driver Multi-Car Good Student Alternative Fuel Payment by Electronic Funds Transfer (EFT) Planning Ahead (Advance Purchase Discount) Transfer from Preferred Carrier Non-Smoker Home Renovation New Home New Roof UL Approved Roofing Materials Home Safety Protective Devices Golf Cart (Home Discount) Life Insurance Discount Current Policy Renewal Date: MM slash DD slash YYYY Book an AppointmentQuestions or Additional Information to Consider:
