Home Insurance Quote
Fill out the two sections in the preliminary form below and an agent will contact you.
1 - General Information
Name:
Address:
City:
State:
Zip:
Work Phone:
Home Phone:
E-MAIL (
REQUIRED
):
Present Home Insurance Company:
Home Now Insured for:
Date Home Insurance Expires:
Occupation:
How long at your present job:
Number of claims in the last 3 yrs:
Sq. footage of home exlucding garage & basement:
Year home was built:
2- House Information
Type
Construction
Foundation
Roof
1-story
1 1/2-story
2-story
Split Level
BI-Level
Frame or Stucco
Masonry Veneer
Masonry
Basement
Crawlspace
Slab
Asphalt Shingle
Wood Shingle
Tile or Slate
Other
Age of roof
Garage
Bathrooms
Other Features
1 car
2 car
3 car
4+ car
Attached
Detached
Basement
Built-In
Carport
# of Full
# of Half
Central Air Cond.
Central Vacuum
Security System
Wet Bar
Whirlpool Tub
Fireplaces
Basement
Deck, Porch, Patio
# of Chimneys
# of Hearths
Finished (
Yes) (
No)
Sq. Ft.
Deck Sq. Ft.
Porch Sq. Ft.
Screened Patio Sq. Ft.
Hit the "Send Preliminary Request" button below when you've completed this form and an agent will be in contact with you soon. We will not distribute your name, e-mail, phone or address to others.
© 2008 Alexander & Alexander Insurance Services
