Home Insurance

The BETTERWAY to get Home Insurance.

Personal Information

1. Your Name(required)
2. Email(valid email required)
3. Phone
4. Gender
5. Male Female
6. Credit Rating Poor Good Excellent Unsure
7. Best time to call

Property Information

1. Address
2. City
3. State
4. Zip Code
5. Property Type Single Family Home Apartment Duplex Condo Townhouse Mobile Home
6. Year Built
7. Ownership
8. Rented Owned
9. Do you live at this property?
10. Yes No

About the Property

1. Construction Type Mostly Brick Mostly Wood Stucco Other
2. Foundation Basement - Fully Furnished Basement - 1/2 Finished Basement - Unfinished Crawlspace Slab Other
3. Roof Asphalt Shingle Wood Shingle Tile Concrete Other
4. Primary Heating Gas (Forced Air) Electric Hot Water/Steam Radiator Oil/Coal/Kerosene Propane Stove
5. Bedrooms 1 2 3 4 5 6 7+
6. Bathrooms 1 1.5 2 2.5 3 3.5 4+
7. Number of Stories One Story Bi-Level Two Story Three Story Other
8. Garage Type Attached - 1 Car Attached - 2 Car Attached - 3 Car Attached - Carport Detacthed - 1 Car Detacthed - 2 Car Detacthed - 3 Car Detacthed - Carport No Garage Other
9. Square Footage (Approximate)
10. Security System None Monitored Unmonitored Unsure
11. Fire Alarm None Monitored Unmonitored Unsure
12. Municipal location
13. Inside City Limits Outside City Limits

Special Considerations

1. Do you have any of the following breeds of dogs: Chow, Doberman, German Shepherd, Pit Bull, Rottweiler, Wolf Hybrid, or a mix of these?
2. Yes No
3. Is your home located in a flood plain?
4. Yes No
5. Select any additional property features that apply (optional): Dead Bolts Fire Extinguisher Trampoline Covered Deck/Patio Swimming Pool

Coverage Information

1. Replacement cost of dwelling (not including land)
2. Personal liability coverage 100,000 300,000 500,000 1,000,000
3. Desired deductible $250 $500 $1000 $2000
4. Have you reported any claims or losses to your insurance company within the past 5 years?
5. Yes No
6. Will this insurance replace an existing policy?
7. Yes No
8. Are you interested in Mortgage Protection coverage?
9. Yes No

1. Other Information

 

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