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Online Quotes - homeowner

Please provide as much information as possible when filling out the online form(s). If there are questions you cannot or choose not to answer, we will review and discuss by phone at a convenient time.

Name: DOB:
Spouse: Spouse DOB:
City: State: Zip:
Phone: Best time to be reached by phone:
  Is your home inside city limits? yes no
  What type of foundation does your home have?
     If crawlspace, is it enclosed with anything?
  Do you have any business on the premises? yes no
     If so, what type?
  What year was your home built?
  What is the total square footage?
  If your home is over 20 years old, when was the last time the following were updated?
  Electrical Heating Plumbing
  What type of construction is your home?
  What type of roof do you have?
     If metal roof, what gauge is the metal?
  Who do you currently have your home insured with?
  How do you currently pay your homeowners premium?
  What is your current annual premium?
  What is your current deductible?
  When does your current policy renew?
  Have you had any losses in the past 3 years? yes no
   If so, what date and type of loss did you have?
  How much do you currently carry on the following?
  Dwelling Unattached Structures Medical Payments
Contents Liability
  Does your home have deadbolt locks smoke detectors and fire extinguishers?
  Does your home have a monitored alarm system? yes no
  What is your primary heating type?
  Do you have a porch or a patio attached to your home?
     If so, what is the square footage?
  Do you have a carport or garage?
     If so, how many vehicles?
  Do you have a wood burning stove or fire place?
  Do you have a trampoline or swimming pool?
     If so, are they fenced with a locking gate? yes no
  Do you have any pets or animals on your premises? yes no
     If so, what type?
     Are they aggressive and have they ever bitten anyone?
  How many bedrooms and bathrooms does your home have? BR BA
  Do you want to include any of the following endorsements on your policy, if available?
  Refrigerated Food Coverage Identity Fraud Coverage
  Do you carry at least $1 million excess liability protection? yes no
     If not, would you like a quote? yes no
  Who is your auto insurance currently with?
     Would you be interested in a quote? yes no