Homeowners Insurance Quotes "*" indicates required fields Named Insured* Second Named Insured if applicableEmail* Phone*Alt PhoneReferred By*Select OneGoogleOtherRadioPlease specify referral source* Which radio show?* Greg and Dan Phil Luciano Mailing Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Insured DOB* MM slash DD slash YYYY Secondary Insured DOB MM slash DD slash YYYY Is your location address different from your mailing address?* Yes No Location Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Property DetailsPlease completed all areas for best quote possible. Year Built*Replacement*Market Value*Roof Type*Select OneAsphalt ShingleTileSlateMetalWood ShakeRolled Rubber RoofingTar and GravelConstruction Type* Vinyl Solid Brick Aluminum Log Wood Other % Vinyl* % Solid Brick* % Aluminum* % Log* % Wood* Type of Material and %* Total Sq. Ft of 1st Floor* Total Sq. Ft of 2nd Floor* Total Sq. Ft of Basement* Foundation Type* Basement Crawlspace Slab Crawl Space %* Slab %* Basement %* % of Basement Finished* How many stories?*11.522.5Bi-LevelTri-LevelPorch(es)?* Yes No Porch(es) Sq. Ft* Deck(s)?* Yes No Deck(s) Sq. Ft* Balconies?* Yes No Balconies Sq. Ft* Scheduled Items?* Jewelry Guns Furs Other Jewelry $* Guns $* Furs $* Other $* Is there a fireplace?* Yes No Wood #* Gas #* Hearth #* Chimney #* Is there a wood burning stove?* Yes No Wood Burning Stove Location* Water Back Up?* Yes No Sump Pump?* Yes No Power Backup?* Yes No Type of Water Back Up, Sump Pump, Power Backup* Heating Year?* Wiring Year?* Wiring Type*Select OneFusesBreakerKnob and TubeAmps*Select OneLess than 100100200Plumbing Year?* Roof Year?* Pets in home?* Yes No Please specify breed(s)* Pets coverage?* Yes No Heat Source* Solar Power?* Yes No Solar Cost* Central Air?* Yes No Garage?* Attached Detached Number of Stalls* Other Structures?* Yes No Other Structures $* Trampoline?* Yes No Netted?* Yes No Swimming Pool?* Yes No Type of Pool* Above Ground In-Ground Slides?* Yes No Diving Board?* Yes No Fenced?* Yes No Number of Full Bathrooms* Number of Half Bathrooms* Current or Desired Deductible?* $500 $1000 $1500 $2000 Earthquake?* Yes No Identity Theft?* Yes No Personal Umbrella?* Yes No Current Insurance Comp* Current Annual Premium* Requested Effective Date* MM slash DD slash YYYY Responding Fire Department* Miles to Fire Station* Number of Acres* In city limits?* Yes No Feet from Hyrdrant* Mortgage Company Present* Have you had any claims in the last 5 years?* Yes No Please list the date of losses, description, and amount paid out*Would you like to upload a copy of the declaration pages of your policy?* Yes No Declaration Pages of Policy* Drop files here or Select files Max. file size: 60 MB. Would you like to upload front and back photos of your house?* Yes No Photos of House* Drop files here or Select files Max. file size: 60 MB. EmailThis field is for validation purposes and should be left unchanged.
