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Landlord Insurance Quote

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The state where you need insurance coverage*

Unfortunately, we are only licensed to provide insurance in California, Oregon and Washington states.

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State Zip Code

Same as Mailing Address?*

Yes

No

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth*

MM slash DD slash YYYY

Occupation*

What is your marital status?*

Married

Widowed

Separated

Divorced

Single

Spouse's Name*

First Last

Spouse's Email*

Spouse's Phone*

Spouse's Date of Birth*

MM slash DD slash YYYY

Spouse's Occupation*

Are you a member of a Mennonite Church?*

Yes

No

Name of church where you are a member*

Losses in Five Years*

Yes

No

Please Explain*

Is property located within*

City

Rural

Mountain

Is property rented out sometimes?

Yes

No

Year Built*

Square Feet*

Number of Stories*

One

Two

Three

Would you like to be quoted for earthquake insurance?*

Yes

No

Cripple Wall

Yes

No

Basement?*

Full

Partial

None

Basement Square Feet

Foundation*

Cement Slab

Crawl Space

Other

Exterior Walls*

Stucco

Wood Siding

Clapboard

Other

Architectural Style*

Ranch

Cottage

Contemporary

Tract Home

Custom

Other

Home Shape*

Rectangle

L-Shaped

H-Shaped

U-Shaped

T-Shaped

Complicated

Contemporary

Other

Construction Quality*

Average

Above Average

Expensive/Custom

Other

Type of Roof*

Comp Shingle

Wood Shingle

Ceramic Tile

Concrete Tile

Wood Shake

Other

Garage*

None

Attached

Detached

Built-in (Living Space Above)

Number of Cars

Porches*

Yes

No

Porch Square Feet

Patios*

Yes

No

Patio Square Feet

Breezeways*

Yes

No

Breezeway Square Feet

Swimming Pool*

Yes

No

Is Pool Fenced?

Yes

No

Diving Board or Slide?

Yes

No

Type of Cooling*

Central

Evaporative

Other

Type of Heating*

Central

Wall Furnace

Floor Furnace

Wood Stove

Other

How many wood stoves?

Is this your Primary Heat Source?*

Yes

No

Smoke Detectors?*

Yes

No

Are there animals on the property?*

Yes

No

What kinds of animals and how many?

If there are dogs, what breeds?

Have any of your animals injured someone?*

Yes

No

Any Business on Premise?*

Yes

No

What kind of business?

Some common examples are: farming, piano lessons, home day care, product sales, repairs, arts & crafts, consulting, home maintenance or cleaning, food preparation and sales, tutoring or teaching, and animal boarding.

Distance to Fire Hydrant*

Over 1,000 feet

Less than 1,000 feet

Distance to Fire Department*

Over 5 Miles

Less than 5 Miles

Detached Structures?*

Yes

No

Describe the structure

Solar Panels?*

Yes

No

Do you currently have homeowners insurance?*

Yes

No

If home built prior to 1960, have Plumbing and Electrical been upgraded?*

Yes

No

Please Explain

Finishing Comments

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PO Box 878
1110 J St., Reedley, Ca 93654
559.638.2327
[email protected]

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