In house quote form First Name:* Last Name:* Phone number:* Is it ok to text?* Yes No Email address:* Property address:* Property address City:* Property address Zip Code:* Occupancy of house:* Owner occupied - primary residence Owner occupied - secondary residence Owner occupied - seasonal residence Tenant occupied - 12 month lease Tenant occupied - less than 12 month lease Vacant Property type:* Single family home Townhouse Condo Multi-family (2 or more units) New purchase/Prior insurance:* This is a new purchase Prior insurance exists with no lapse Prior insurance exists with less than 45 day lapse No prior insurance Gated community?* No Yes - gate only Yes - gate and guards Does the house have a monitored alarm system? (An alarm certificate from the monitoring company will be required to grant the credit)* No Yes - for burglar only Yes - for fire only Yes - burglar and fire Age of roof?* Storm shutters/Impacts?* Any claims in the past 5 years at this or any other property owned by you? If yes, give date, type of claim, amount paid and is the claim still open?* Any pets? If yes, give type, breed and bite history:* Any bankruptcies, foreclosures or repossessions in the past 5 years?* Yes No Who referred you?* Additional information
