CA insurance quotes from Imperial Insurance Agency.com CA Insurance quotes from anthony@imperialagent

CA Insurance quotes from anthony@imperialagent

California insurance quotes from Imperial Insurance Agency.com
California insurance quotes from Imperial Insurance Agency.com
Imperial Insurance Agency.com Insurance
California personal and business insurance quotes from Imperial Insurance Agency.com
California auto, home and business insurance quotes from Imperial Insurance Agency.com

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Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
Your "County" is?
State: (Must be California)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
Primary Insured's Occupation:
 
Primary Policyholder's Birthdate:
(REQUIRED - Some companies products
offer discounts for certain age groups.)
 
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Is this Builder's Risk?
(new home constr.)
NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
 
Type foundation: Basement
Slab
Crawlspace over slab
Other (list in remarks)
(If basement, what % is finished?)
% FINISHED
 
Type Construction: Frame
Brick/Veneer
Stone
Other (list in remarks)
 
Type Roof: Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Does Home Have a Garage? Yes No
Tell whether built in, detached/attached, and how many cars?
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Rate Your Credit History and Past Insurance Payment History:
(Some companies products are
based on your credit and payment history.)
Excellent Fair
Poor Horrible
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
 
Heating Type: Gas (Propane or natural)
Electric
Oil (if oil, list tank location in remarks)
 
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here):
 
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Regular Mail
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