AUTO, HOME, UMBRELLA

INITIAL CONSULTATION APPOINTMENT

Thank you for scheduling your Personal Line Property & Casualty Insurance Review

STEPS 2 AND 3

PLEASE COMPLETE at least 3 – 5 days PRIOR TO APPOINTMENT

This will help us prepare and make the best use of your time and provide a thorough and professional insurance consultation.

Click on each of the boxes below for details.

---> 2. Send HTA your current Insurance Declaration Pages
HTA must have your Declaration Pages at least 3-5 days prior to your appointment to allow us to prepare.
Send HTA your current insurance policy Declarations Pages (this is the summary page that shows your coverages and premium)

3 easy ways to send:

Upload into the Short Intake Form below

Email to AutoHome@HTA-insurance.com

Text 610-795-5187 (this number is for texting only-this number does not accept phone calls)

---> 3. Complete a SHORT INTAKE FORM
HTA will not be able to research other options until this intake form is complete.

Please complete at least 3-5 days prior to appointment to allow us to prepare.
Personal Insurance Review

Information Needed for Personal Insurance Review

First Name (as it appears on your Driver's License)(Required)

Last Name (as it appears on your Driver's License)(Required)

Email Address(Required)

Date of Birth(Required)
MM slash DD slash YYYY

Please upload the Declarations pages from each of your policies

Drop files here or

Max. file size: 50 MB.

HTA needs your declarations pages 3-5 days prior to your appointment to prepare properly. If not received, we will need to reschedule your appointment. If you are not comfortable uploading, you can email them to AutoHome@HTA-insurance.com or text to 610-795-5187
Select which coverages you would like to review(Required)
Auto Insurance
Homeowners Insurance
Umbrella Insurance
Other
Auto Insurance Questions
Please include information on all drivers in your household
How long have you been with your current company (approx years)?(Required)
How many vehicles are in your household?(Required)
How many drivers are in your household? (INCLUDING you)(Required)
Driver 1 Information (YOU)
Drivers License #(Required)

Driver 2 Information
Full Name(Required)

Relationship to you(Required)

Date of Birth(Required)
MM slash DD slash YYYY

Drivers License #(Required)

Driver 3 Information
Full Name(Required)

Relationship to you(Required)

Date of Birth(Required)
MM slash DD slash YYYY

Drivers License #(Required)

Driver 4 Information
Full Name(Required)

Relationship to you(Required)

Date of Birth(Required)
MM slash DD slash YYYY

Drivers License #(Required)

Driver 5 Information
Full Name(Required)

Relationship to you(Required)

Date of Birth(Required)
MM slash DD slash YYYY

Drivers License #(Required)

Driver 6 Information
Full Name(Required)

Relationship to you(Required)

Date of Birth(Required)
MM slash DD slash YYYY

Drivers License #(Required)

Homeowners Insurance Questions
Tell us about your property:
How long have you been with your current company (approx years)?(Required)
Do you have any of the following?(Required)
Includes a swimming pool
Includes a trampoline
There are farm animals or exotic pets living on this property
There are dog(s) living on this property
Business is conducted from the property
Household employees (Housekeepers, Nanny, etc.) live on the property
none of the above
(check all that apply)
Approx Year Roof last updated or replaced?(Required)

Have there been any updates to the Heating, Plumbing and/or Electrical? If so, in what year?(Required)

Umbrella Insurance Questions
Select any items below that you may own:
Automobiles
Owned properties (Primary, Secondary or Rental)
ATVs, Boats, Jet Skis and/or Motorcycles
Other Insurances
Provide information on the other insurance coverage you would like to discuss:
Additional Information
Provide any additional details or questions you may have so we can best prepare for your appointment:

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The 2m 37s video below will show you exactly what to expect on your journey with HTA.

Please reach out to use directly with any questions or for assistance

610-430-6650, Option 2

By submitting the information above, you are agreeing to be contacted by a Licensed Sales Agent by email or phone call to discuss information about Medicare Insurance Plans or Property and Casualty Insurance Plans. This is a solicitation for insurance.

Our Address

347 N. Pottstown Pike
Suite 200
Exton, PA 19341

Contact Us

Info@HTA-insurance.com
P: 610.430.6650
F: 610.430.6652

AUTO, HOME, UMBRELLA

INITIAL CONSULTATION APPOINTMENT

Thank you for scheduling your Personal Line Property & Casualty Insurance Review

STEPS 2 AND 3

PLEASE COMPLETE at least 3 – 5 days PRIOR TO APPOINTMENT

Click on each of the boxes below for details.

Contact Us

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