Dwelling Fire Insurance Quote Request Form
Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.
| Full legal property/location address
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| Number of Units
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| What is the closing date and/or the purchase date?
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| If not a new purchase, what is the home currently insured for?
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| What year was your home built?
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| Do you have planned renovations on the rental home? If so, please provide details
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| What is the estimated market value of the home AFTER you have completed renovations? (If you answered "no" to the above question, please input current market value.)
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| What is the style of your home?
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| What is the occupancy type? (Is the home currently rented, or is it vacant? If vacant, please advise when you expect it to be rented out.)
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| What is the square footage of the home? (Not including the basement or built-in garage)
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| Is it built on basement, slab or crawlspace? What percentage?
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| If there is a basement, what % is finished? Is it a walk-out or daylight?
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| What is the home's construction type?
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| What type of siding is on the home?
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| What is the garage type and number of stalls? (Ex: Attached 2-stall, Detached 3-stall, built-in)
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| Please describe all home claims made in the last 5 years? Please include date and reason for claim. (Type NA if not applicable)
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| Do you have any outbuildings, such as a shed or barn? Please list size, value and condition (Type NA if not applicable).
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| What group or association are you or your spouse a member of? (Check all that apply)
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| Do you and your spouse have a college degree? If so, what level of degree and where from? (Ex: Bachelors from University of Michigan)
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| Please advise the year each of the following four categories were updated: Roof, Electrical/Wiring Box, Plumbing, HVAC/ furnace (to the best of your knowledge)
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| Does the home have buss fuses, or a Breaker Box? If a breaker box, is the home on a 100amp service box, 200amp service box, or different amp amount?
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| What type of HVAC does the home have?
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Hold down the Ctrl Key to make multiple selections. |
| Please advise if you have a free-standing wood/pellet burning stove or if you have an open fireplace. If you have an open fireplace, please advised if it has been framed-in and if it is able to be used or not.
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| Is there a pool, trampoline, fireplace, wood/pellet stove in the home?
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| Does the tenant have any pets or dogs? If so, please advise what kind/breed of pet/dog, and how many. If not, please advise if you would allow this down the road for future tenants.
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| Have there been any property claims in the last 5 years? Please provide details for all properties owned..
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| Do you have a mortgage? If so, will it be escrow billed?
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| Additional Comments
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Submission Validation Required |
Enter the Validation Code from above.
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Important NoticeAny
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
contact us. Per the terms of our
online privacy policy we will not resell your information to any third-party.
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