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Homeowner Quote

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Home / Homeowner Quote

Homeowner Quote

Step 1 of 12

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Name, Address and Contact Info
Name*

First
Last
Home Phone*
Work Phone
Email*
Referred By

Prior Insurance
Name Your Prior Insurance Provider
Have Insurance with them for*
Estimated Yearly Premium (in US$)
Prior policy ends*

Property General
Address*

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Property Surroundings*
Distance to fire station*
Distance to Hydrant (ft)*
- Under 1,000 ft
- Over 1,000 ft
Year built
Property Use*
Square footage*
How many families are living in the home?*
Number of Stories*
Type of Dog*

Property Values
Purchase Date*
Purchase Price*
Est. Current Market Value*
Est. Replacement Value*

Construction Details
Construction Type*
Roof Material*
Age of Roof
Electrical Type*
Heat Type*
Number of Fireplaces*
Number of Bathrooms*

Protection Devices
Burglar Alarm*
Fire Alarm*
Smoke Detectors*
Fire Sprinkler System*

Building Details
Number of Basements
Est. Square Footage of Basement(s)
Basement Finished %
Garage Type*
Est. Square Footage of Garage

Other Structures
Swimming Pool Type*
Swimming Pool Fence Construction Type
Has Diving Board
- Yes
- No

Applicant Information
Date of Birth*
Marital Status*
Years at Current Address
Years at Previous Address
Occupation*
How many years have you been with your current employer?
How many years were you with your previous employer?
SSN #
Rate your Credit

Co-Applicant Information
Relationship to Applicant
Name

First
Last
Date of Birth
Occupation
How many years have you been with your current employer?
How many years were you with your previous employer?
SSN #

Additional Information
Have you had any reported losses during the past 3 years?*
- Yes
- No
Any business conducted on premises? (including day/child care)*
- Yes
- No
Any residence employees?*
- Yes
- No
Any residence employees?*
- Yes
- No
Has application had a foreclosure, repossession or bankruptcy during the past five years?*
- Yes
- No
Does applicant own any recreational vehicles (snowmobiles, dune buggies, mini bikes, ATVs, etc.)?*
- Yes
- No
Is building retrofitted for earthquake?*
- Yes
- No
- Not Sure

Basic Coverages
Dwelling*

Name your Limit
Other Structures*

Name your Limits and % Base
Personal Property*

Name your Limits and % Base
Loss of Use*

Name your Limits and % Base
Personal Liability*
Medical Payments*
Deductibles
All Perils Deductible*
Credits
Non-Smoking Household
- Yes
- No

Insurance Companies

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