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Address:
14007 Telge Rd
Cypress, Texas 77429
Phone:
(281) 256-8310
Email:
agency@onckeninsurance.com
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Home
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Our Team
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Leave A Review
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Service Areas
Georgetown, TX
Cypress, TX
Cedar Park, TX
Round Rock, TX
College Station, TX
Waco, TX
Austin, TX
San Antonio, TX
Spring, TX
Katy, TX
Jersey Village, TX
Woodlands, TX
Klein, TX
Willowbrook, TX
Fairfield, TX
Towne Lake, TX
Houston, TX
Tomball, TX
Client Portal
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Annual Client Questionnaire – Personal Lines
Step
1
of
11
9%
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Are you driving for a rideshare or delivery company?
(Required)
Yes
No
If yes what company?
Have you started using your vehicle for business?
(Required)
Yes
No
(Roofing, real estate, advertisement, etc.)
What Business?
Please check all life events that have occurred in the last 12 months.
(Required)
Address Change
Birth of a child
Career Change
Driver Added
Driver Removed
Home renovations/improvments
Marital Status
Purchased ATV/Motorcycle/Slingshot
Purchased Boat
Purchased Home/Rental Property/Second Home
Started A Business
Vehicle Bought
Vehicle Sold
Other Change
No Changes
Date You Moved
(Required)
MM slash DD slash YYYY
Updated Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Congrats on the new career! What is your new job title & employer?
(Required)
Driver Added To Policy
First
Last
Birthday
Relationship to You
Spouse
Child
Parent
Other
DL #
Driver Removed From Policy
First
Last
What is your current marital status?
Married
Divorced
Widowed
Spouse Name
What new toy(s) did you purchase?
ATV
Boat
Golf Cart
Motorcycle
Slingshot
List make, model and estimated purchase price for each new toy.
Year
Make
Model
Add
Remove
Click the + to add more rows.
What type of property did you purchase?
Primary Home
Rental Home/Investment Property
Second Home/Vacation Home
Date Purchased
MM slash DD slash YYYY
New Property Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is the Property currently insured? With who?
What is the name of your business?
What is the industry of your new business?
Is your business currently insured?
Yes
No
Date Purchased
MM slash DD slash YYYY
Year/Make/Model of purchased vehicle(s)
Year
Make
Model
Add
Remove
Click the + to add rows for additional vehicles.
Date Sold
MM slash DD slash YYYY
Year/Make/Model of sold vehicle(s)
Year
Make
Model
Add
Remove
Click the + to add rows for additional vehicles.
Please list the renovations and an approximate cost of each.
Add
Remove
You can use the + button on the right side to add additional rows.
Do you have life insurance independent of your employment?
(Required)
Yes
No
Not Sure
Please select all property that you own even if it is not insured with our agency.
(Required)
ATV
Auto
Boat/Yacht
Business
Classic Car
Condo
Golf Cart
Home
Motorcycle
Rental Property
RV
Slingshot
Snowmobile
Vacation Property
Nothing to Add
It is important to know if you own any of the items above because coverages can overlap or leave gaps and you need to be covered correctly.
Are there any additional changes that we should know about prior to your insurance renewal?
Signature
(Required)
Comments
This field is for validation purposes and should be left unchanged.
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