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Get a Detailed Quote – Home Insurance
aiinsure
2020-09-03T21:29:28+00:00
Home Insurance Quote
Step Two:
Fill Out The Form Below
Referred By: (Name/Company)
Closing/Renewal Date:
*
MM
DD
YYYY
Personal Info
Name
*
First
Last
Phone
*
DOB
*
MM
DD
YYYY
Choose one:
*
Primary
Secondary
Rental
Do You Need a Flood Quote?
*
Yes
No
Email
*
Second Personal Info (if any)
Name
First
Last
DOB
MM
DD
YYYY
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Choose one:
Primary
Secondary
Rental
Previous address:
Current insurance carrier:
How many years have you been insured?:
Current carrier premium:
Current deductible:
Property Info
Year built:
Sq. ft:
# of stories:
Updates to roof:
Updates to HVAC:
Updates to electrical:
Updates to plumbing:
% of Vinyl exterior walls:
% of Solid Brick exterior walls:
% of Brick Veneer exterior walls:
% of Hardy Plank exterior walls:
% of Stucco exterior walls:
% of Arch Shingles roof:
% of Solid Brick roof:
% of Tile roof:
% of Metal roof:
% of Slate roof:
% of Wood Shake roof:
Foundation type:
# of Bathrooms:
# of Bedrooms:
*
# of Fireplaces:
Type:
Garage:
Attached
Built In
Detached
None
Carport
# of Cars in garage
% of Carpet flooring:
% of Tile flooring:
% of Hardwood flooring:
% of Vinyl flooring:
% of Paneling flooring:
% of Other flooring:
% of Painted interior walls:
% of Wallpaper on interior walls
% of Tile on interior walls
% of Paneling on interior walls
% Other for interior walls
Deck:
Yes
No
# of decks:
Size(s):
Breezeway:
Yes
No
Size:
Choose one:
*
Screen
Open
Patio:
Yes
No
Size:
Choose one:
Covered
Open
Screened
Swimming pool:
Yes
No
Hot tub:
Yes
No
Sauna:
Yes
No
Wet bar:
Yes
No
Trampoline:
Yes
No
# of skylights:
# of stained glass windows:
Shutters:
Yes
No
Engineering shutters:
Yes
No
Professional installed:
Yes
No
Are shutters on ALL windows and doors:
Yes
No
Explain:
Burglar alarm?
Yes
No
Monitored by:
Do you have any pets?:
Yes
No
What breed:
Coverage Info
Dwelling ($):
Other Structures ($):
Personal property ($):
Liability:
300k
500k
Medical coverage:
1k
5k
10k
25k
Deduct:
1k
2.5k
5k
10k
Earthquake coverage:
Yes
No
Flood coverage:
Yes
No
Is home in wind/hail pool?:
Yes
No
Other Info
Have they filed any homeowners claims in the past 5 years?:
Yes
No
Explain:
Special Instructions (if any)
Document Upload (Current HO Declaration Page, Flood Declarations Page, Elevation Certificate, etc)
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