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Provide a few details below so our Private Client Group can better understand your needs and connect you with the appropriate advisor.
Required fields are marked with an asterisk (*).

Personalized Insurance Guidance

The Private Client Group at Wheeler & Taylor Insurance works with 25+ leading insurance carriers to help you secure broader protection, stronger positioning in the marketplace, and a higher level of personal service than direct online insurers — serving clients since 1871.

✓ Reviewed by a real advisor — not an automated system
✓ Personalized recommendations from multiple carriers
✓ Identify opportunities to strengthen your coverage strategy
✓ Boutique, concierge-level service tailored to your needs

Let’s Get to Know You

First Name *

Last Name *

🛡️ Your information is kept confidential and reviewed by the Private Client Group at Wheeler & Taylor Insurance to ensure accurate coverage guidance.

Physical Address

Please provide the physical address of the property. This helps us accurately determine your coverage and rating.

Property Address *

City *

State/Province *

ZIP / Postal Code *

Primary Residence Or Secondary Home? *Primary ResidenceSecondary Residence

Current Coverage InformationCurrent CarrierPUREChubbAIGCincinnatiBerkley OneOther

Name Of Carrier

Replacement Cost

USD

Household Structure *Is There A Secondary Insured?YesNo

First Name *

Last Name *

Home Safety & Protection Features

Tell us about the safety and protection systems in your home, including fire, security, and prevention features.

Fire Protection Systems *Fire Alarm?YesNoNot Sure

Who Is It Monitored By?Central StationLocal

Are There Fire Extinguishers?YesNoNot Sure

Are There Sprinklers?YesNoNot Sure

Security & Monitoring System *Burglar Alarm?YesNoNot Sure

Who Is It Monitored By?Central StationLocal

Property Protection Systems *Automatic Water Shut Off?YesNoNot Sure

Low Temperature Alarm?YesNoNot Sure

Whole Home Generator?YesNoNot Sure

Dwelling Details

Please provide details about the dwelling so we can accurately assess the property.

Style

What Year Was The Roof Replaced?

Collections & Asset Protection

Please provide details about valuable personal property and collections that may require scheduled coverage or enhanced protection.

Do you have any high-value personal items that should be scheduled separately? *YesNo

Total Jewelry Value:

USD

Total Wine Value

USD

Total Silver Value

USD

Total Fur Value:

USD

Coverage Details & Property Information

Provide details about your property, coverage selections, and additional features to help us customize your insurance options.

Do You Have Vehicles That Should Be Included In Your Private Client Review?YesNo

How many vehicles should be included?Enter Up To 5 Vehicles

Year, Make & Model

Estimated Value:

USD

Primary UsePersonalBusinessRecreational

Year, Make & Model

Estimated Value:

USD

Primary UsePersonalBusinessRecreational

Year, Make & Model

Estimated Value:

USD

Primary UsePersonalBusinessRecreational

Year, Make & Model

Estimated Value:

USD

Primary UsePersonalBusinessRecreational

Year, Make & Model

Estimated Value:

USD

Primary UsePersonalBusinessRecreational

Outbuildings & Pool

Any Outbuilding(s)? *YesNo

List Outbuildings

Usage

Is There A Pool? *Yes - Below GroundYes - Above GroundNo

Is It Fenced With A Locking Gate?YesNo

Slide?YesNo

Diving Board(s)YesNo

Additional Coverage Options

Let us know if you're interested in added protection beyond your home policy so we can review all available options for you.

Do You Currently Carry Umbrella Or Excess Liability Coverage? *YesNoNot Sure

Current Umbrella Limit:

USD

Do You Employ Household Staff? (Nanny, Chef, Housekeeper, Etc.)YesNo

Any Board Memberships / Executive Roles?YesNo

Any Trust(s) or LLC-Held Assets?YesNo

Additional Properties

Are there additional properties or assets we should include in your review? *YesNo

Secondary home *YesNo

Vacation home *YesNo

Coastal property *YesNo

Rental / Investment Property *YesNo

Condominium / Pied-à-Terre *YesNo

Historic or Landmark Property *YesNo

New Construction or Recently Renovated Home *YesNo

Vacant Property *YesNo

Land / Undeveloped Property *YesNo

Your Private Review Is Almost Ready

We’ve compiled your information into a private client profile based on the details you’ve shared so far.

To deliver your customized private review and ensure we can follow up appropriately, please confirm the best way to reach you.

This information is kept confidential and used only for your private insurance review.

Contact Information *Phone Number

Preferred Contact Time *MorningsAfternoonsEvenings

Email Address *

Final Review & Submit

You’re one step away from completing your private review.

Please take a moment to review your information before submitting. This helps us ensure your quote is accurate and tailored to your needs.

I confirm that the information provided is accurate and complete to the best of my knowledge.

I agree to be contacted to discuss this request and review coverage options.

I understand that this is a request for a quote and does not bind coverage.

Initial

Enter your initials as confirmation of the above statements. *0 / 10

Submit Your Request

Thank you for completing this private client intake.

We personally review each submission with a focus on identifying gaps, improving protection, and aligning coverage with the complexity of your assets.

A member of my team or I will follow up directly to discuss next steps.

Best,
Phil Moroch
Vice President, Private Client Services
pmoroch@wheelerandtaylor.com
d. (413) 300-5175

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