We write insurance polices for your primary home, secondary home, tenant occupied home, vacant home, mobile home and modular homes. We even write policies on the homes you have not started to build yet. If you don't own your home but want to cover your personal property we can insure that as well.

 

 

Name: ___________________________________       ____  

Date of birth:  ________________________________       __

Address:  ____________________       _________________  

City, State, Zip, County:                                                                           

Phone number:                                                                                            

Year the home was built:                                                                         

Square footage:                                                                                          

1 or 2 story:                                                                                                

Exterior construction:                                                                              

Type and age of roof:                                                                                

Is there a fireplace?       yes      no

Is the home within 1000 feet of a firehydrant?                                   

Have you had any losses in the past 3 years?     yes     no

If yes, please explain:                                                                               

                                                                                                                     

How much coverage would you like to have?                                       

  (we base our coverage amount on the replacement value but try to

   get this amount as close to what you are hoping for as possible)

 

If this is a mobile home:

Year:                                                                                                           

Make:                                                                                                         

Model:                                                                                                        

Serial number:                                                                                          

Is the unit permentaly tied down?                                                        

Fully skirted?                                                                                           

Are there any additions?                                                                        

Amount of coverage desired:                                                                 

 

If you need a renters policy:

How much coverage on personal property would you like? The minimum amount of coverage is $25,000.                                         

Remember that is covers all of the items you own - your clothing, shoes, accessories, dishes, pot and pans, furniture, movies, books, electonics and more.

 

If you need a builder's risk:

 

Is this going to be a spec home or your residence?                             

Value of finished home:                                                                           

Have you started building?   yes      no

   If so, how much has been completed?