Windstorm/Hail Acknowledgement Form
Property policies, such as homeowners policies, dwelling policies, and
commercial property insurance policies may exclude coverage for windstorm and
hail events (including, but not limited to, hurricane and tornado). As your
insurance agency, we strongly recommend that you purchase this important
coverage. It is possible that coverage as recommended below may not be
available from the carriers we represent.
I hereby acknowledge the acceptance, rejection, or unavailability of windstorm
and hail coverage as indicated below. It will be conclusively presumed this
election, rejection, and/or acknowledgement of unavailability will apply to all
future renewals, continuations, changes or replacements thereof.
Type Coverage
Accept
Reject
Unavailable
Building Coverage
Personal Property
Applicant’s Signature
Date
Location of Property
Agent/CSR Signature
Name of Agency
Date