HOMEOWNERS QUOTER

Personal Information

When would you like your policy to start?

First name

Middle Name

Last name

Suffix

Birthday

Month

Day

Year

Contact Information

Phone

Address

Is your mailing address the same as the property address?

Yes

Section 2: About the Property

(This section gathers details about the home itself.)

What year was the home built

What's the total square footage

When did you buy the home

Will your name be on the property's deed or legal title?

Yes

Does the applicant have an ownership interest in the property?

Dwelling type

Have you lived at this property for the last 3 years or more?

Yes

Is there a fire hydrant within 1,000 feet (about 3 city blocks) of your home?

Yes

Is the nearest fire station less than 5 road miles away by road?

Yes

Is your home a townhouse or rowhouse (attached to other homes on the sides)?

Yes

How many separate families or households live in the building?

What is the main way you heat your home?

Do you have a backup heating source, like a fireplace or wood stove?

Yes

Is there a wood stove, furnace, or portable kerosene heater in any garage or shed on the property?

Yes

Has the roof been replaced or updated recently?

Yes

Does your home have a specially reinforced 'fortified' roof designed to resist high winds?

Yes

Section 3: Property Use & Safety

(This section asks about potential risks and how the property is used.)

Does any part of your property have existing damage, need repairs, or have any safety issues?

Yes

Is the home currently being built or undergoing major renovations?

Yes

Is the home currently empty or unoccupied?

Yes

Is any part of your property used for a business, including farming or any commercial activity?

Yes

Do you have a swimming pool that is deeper than 2.5 feet?

Yes

Do you have a trampoline on your property?

Yes

Do you own any dogs of a breed that might be restricted by insurance companies, or any pet that has bitten or injured someone?

Yes

Do you own any unusual or exotic pets, such as reptiles, wild animals, or farm animals?

Yes

Does anyone who lives in the home smoke?

Yes

Section 4: Financial & Insurance History

(This section covers past events and financial details.)

In the last 3 years, has a lender started the foreclosure process on this home?

Yes

In the past 5 years, have you had any court-ordered judgments against you, or any liens placed on your property for unpaid debts? This includes claims for things like unpaid taxes, loans, or contractor bills.

Yes

Are there more than two loans (like mortgages) or other legal claims on your property?

Yes

Is any loan on the property from a private individual or a company that isn't a bank or financial institution?

Yes

In the last 5 years, have you been convicted of or charged with any crimes involving dishonesty, such as fraud, bribery, or arson?

Yes

Is the property currently insured

Yes

In the past 5 years, has any insurance company canceled, refused to renew, or declined your application for a policy, for any reason?

Yes

In the past 5 years, how many property damage claims at this home or any other property you've paid to live in?

If more than 3 put down the 3 most recent and we'll reach out to get the rest of the details.

Section 5: Build Your Policy

(This section helps you choose your coverage levels and options.)

Which type of policy would you like?

Basic (Actual Cash Value): This policy covers your home's structure for its current value (minus depreciation). This is a more affordable, essentials-only option.

Comprehensive (Replacement Cost): This policy covers the full cost to rebuild your home and replace your belongings. This is the most popular and protective option.

How much do you want to insure your house for? (Dwelling Coverage)

This should be the estimated cost to rebuild your home, not its market value. Most companies will have a default coverage amount based on the information provided.

How much coverage do you need for your personal belongings? (Personal Property)

Most companies will have a default coverage amount based on the information provided.

How much liability coverage would you like?

This protects you if you're responsible for an accident or injury. Most companies will have a default coverage amount based on the information provided.

Select your policy deductible.

This is the amount you pay out-of-pocket before insurance covers the rest. A higher deductible can lower your premium. Most companies will have a default coverage amount based on the information provided.

Popular Add-Ons (Select any additional coverages you're interested in.)

Water Backup: Coverage for damage from backed-up sewers or drains.

Service Line Coverage: Covers repairs to underground utility lines you're responsible for (water, sewer, etc.).

Identity Theft Protection: Helps with the costs of recovering from identity fraud.

Earthquake Coverage: Covers damage from earthquakes.

Valuable Items: Increased coverage for specific items like jewelry, art, or electronics.

Home Sharing / Renting: Provides protection if you rent out your home on services like Airbnb.

Section 6: Mortgage Protection & Final Details

(This section asks about additional policies and discounts.)

Would you like a quote for Mortgage Protection insurance?

Yes

This is a type of life insurance policy designed to pay off your mortgage if you pass away, ensuring your family can keep the home

Would you like a quote for a separate jewelry policy?

Yes

A separate policy for items like engagement rings protects them fully and ensures that a jewelry claim won't affect your homeowners' policy rates or history.

How do you prefer to pay?

Monthly

Quarterly

Bi-Annually

Annually

Who is your auto insurance Carrier?

Are you a member of any of these organizations? (This may qualify you for a discount.)

Armed Forces Insurance

USAA

None

Schedule an appointment

Oct - Nov 2025

Week starting Sunday, October 26

Time zone: Coordinated Universal Time (UTC)Phone call

Friday, Oct 31

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM