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Let’s Get to Know You

🛡️ This confidential and secure intake is reviewed directly by Bill Harriman, Account Executive with the Private Client Group at Wheeler & Taylor.

Physical Address

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

Primary Residence Or Secondary Home? *
Current Coverage InformationCurrent Carrier
Name Of Carrier
Replacement Cost
USD
Household Structure *Is There A Secondary Insured?

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?
Who Is It Monitored By?
Are There Fire Extinguishers?
Are There Sprinklers?
Security & Monitoring System *Burglar Alarm?
Who Is It Monitored By?
Property Protection Systems *Automatic Water Shut Off?
Low Temperature Alarm?
Whole Home Generator?

Dwelling Details

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

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? *
USD
USD
USD
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?
Enter Up To 5 Vehicles
USD
Primary Use
USD
Primary Use
USD
Primary Use
USD
Primary Use
USD
Primary Use

Outbuildings & Pool

Any Outbuilding(s)? *
Is There A Pool? *
Is It Fenced With A Locking Gate?
Slide?
Diving Board(s)

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? *
USD
Do You Employ Household Staff? (Nanny, Chef, Housekeeper, Etc.) *
Any Board Memberships / Executive Roles? *
Any Trust(s) or LLC-Held Assets? *

Additional Properties

Are there additional properties or assets we should include in your review? *
Secondary home *
Vacation home *
Coastal property *
Rental / Investment Property *
Condominium / Pied-à-Terre *
Historic or Landmark Property *
New Construction or Recently Renovated Home *
Vacant Property *
Land / Undeveloped Property *

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.

Phone Number
Preferred Contact Time *

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.

Initial

0 / 10

Submit Your Request

Thank you for completing this private client intake.

I 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,
Bill Harriman
Account Executive, Private Client Services
Wheeler & Taylor Insurance
bharriman@wheelerandtaylor.com
d. (908) 363-7471