| No
coverage is bound until you are contacted by one of
our representatives |
Homeowner
Insurance Quote |
| CONTACT INFORMATION |
| 1. What year was this home built? |
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| 2. What type of construction was used? |
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| 3. What style is your home? |
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| 4. How will your home be used? |
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| 5. How many square feet on the first floor? |
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| 6. What type of home do you have? |
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| 7. How many total square feet in your home? |
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| 8. Do you have a fireplace? |
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| 9. If yes, please describe what type |
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10. Do you have a woodstove? |
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| 11. If yes, please describe type and use |
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| 12. Do you have a garage? |
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| 13. If yes, please describe what type |
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| 14. What is your primary source of heat? |
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| 15. What is your secondary source of heat? |
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| 16. Do you have a security system? |
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| 17. If yes, please describe what type |
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| 18. Have you had any losses in the past 3 years? |
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| 19. If yes, please describe |
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| 20. Is this your first home? |
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| 21. If no, do you have current insurance? |
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| 22. Do you own any pets? |
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| 23. If yes, Please describe |
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| 24. Any hot tub, swimming pool, sauna, wet bare etc? |
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| 25. If yes, Please describe |
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| 26. Any updates that have been done on home, (i.e.,
new roof, electrical, heating, retrofitting, etc). |
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| If yes, Please enter date complete and describe |
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| COVERAGE INFORMATION
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| 1. Do you want earthquake coverage? |
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| 2. Do you have collections worth over $500? |
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| 3. If yes, Please describe |
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| 4.Do you have any single piece of jewelry valued over
$500? |
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| 5. If yes, Please describe |
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| 6. Do you have work tools that need coverage? |
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| 7. If yes, Please describe |
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| 8. Do you operate a business out of your
home? |
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9. If yes, Please describe |
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