Stoker Insurance Solutions

Please complete the questionnaire below and click the “submit” button at the bottom of the page. Please note, some questions may not apply to your unique situation and may be left unanswered.

Fields marked with a * are required.

After submitting your questionnaire, fax or email copies of your current insurance declaration pages to 916-933-1735 or nathan@stokersolutions.com.

Client Contact Information:

*Name:
Mailing Address:
City:
State:
Zip Code:
*Email Address:
Spouse Email Address:
Home Phone:
Work Phone:
Cell Phone:

Account Information:

Exposure Type	Total #
Residences:
Rental Properties:
Automobiles:
Motorcycles:
Unregistered vehicles:
Other motor vehicles:		Describe:
Number of licensed drivers in household:
Watercraft:
Aircraft:
Value of Collectibles (jewelry, art, etc.):
Non-profit board positions:
For-profit board positions:
Current Umbrella/Excess Liability:
Other account-related comments:

Current Insurance Information:

Please provide the name of your current insurance company for:

Automobiles:
Homes:
Umbrella/Excess Liability:
Valuable Collections:
What is the primary reason for reviewing your insurance program (cost, coverage concerns, etc.)?
What do you most appreciate about your current agent/broker and/or insurance company?

Personal Risk Management > Online Questionnaire

Online Questionnaire