Homeowners Insurance Quote Request | Fish & Associates Insurance

Your Name *

Your Mailing Address *

City *

State *

Zip Code *

E-mail Address: *

Daytime Phone Number *

Property Information

In what year was your home built? *

What is the construction type of your home? *

Approximate Square Footage: *

Number of Stories: *

Foundation: *

If basement, percent finished: *

Wood, coal or pellet stove in house or any outbuilding? *

Yes

No

Do you have a swimming pool? *

Yes

No

If Yes, is the pool: *

Do you have a trampoline? *

Yes

No

If Yes, is the trampoline: *

Central Station Fire/Burglar Alarm System: *

Yes

No

Distance to the nearest fire hydrant? *

Number of acres: *

Any land farmed? *

Yes

No

Age of Furnace: *

Do you have any pets? *

Yes

No

If yes, list type(s) / breed(s) *

If yes, any history of biting or viciousness? *

Horses or other livestock? *

Yes

No

If yes, give specifics: *

Any insurance claims in last 5 years? *

Yes

No

If yes, give details. Be sure to include the date of loss, type of loss and amount paid. *

Current Coverage on House: *

Current Personal Liability Limit: *

Current Deductible: *

Current Premium: *

Medical Payments *

Valuation of Home: *

Personal Property Valuation: *

In what County/Township are you located? *

Do you have smoke detector(s) installed? *

Yes

No

Home Updates:

Enter year updates were made. If year not known, enter "unknown":

Roof: *

Plumbing: *

Wiring:

Heating:

Optional Property Coverages: *

Earthquake Coverage Requested

Flood Coverage Requested

Sewer/Water Backup Coverage Requested

Property Floaters - Indicate limits below:

Antiques: *

Furs: *

Coins: *

Jewelry: *

Computers: *

Stamps: *

Fine Arts: *

Tools: *

Other Floater Coverage: *

Limit of Insurance: *

Additional Comments

Please use the box below to enter any additional information you feel should be considered:

Protecting your privacy and identity is very important to us.

Your Social Security and drivers license numbers may be required to complete this quote. We will contact you personally for this information.

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