Secondary Insurance Quote - Mennonite Insurance

Homeowners 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*

Physical Address*

Street Address Address Line 2 City State Zip Code

Is Billing Address the same as Physical Address?

Yes

Billing Address

Street Address Address Line 2 City State Zip Code

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*

List all the owners of the property and their interest in the property.*

Include trusts, LLCs, partnerships, corporations, and other entities.

Do you have other persons who reside on the premises?*

Yes

How many other persons reside on the premises?*

List the names, dates of birth, and relationship of all other persons who reside on the premises

Name

First Last

Date of Birth

MM slash DD slash YYYY

Relationship

Do you have another person to add?

Yes

Name

First Last

Date of Birth

MM slash DD slash YYYY

Relationship

Do you have another person to add?

Yes

Name

First Last

Date of Birth

MM slash DD slash YYYY

Relationship

Do you have another person to add?

Yes

Additional Names, Dates of Births, and Relationship

Losses in five years?*

Yes

Please Explain

For each claim, list: date of loss, amount of loss, and whether claim is closed or still open.

Are you a member of a Mennonite Church?*

Yes

Name of church where you are a member*

How did you hear about us?

Have you been denied insurance in the last three years?*

Yes

Why were you denied insurance in the last three years?

Is Property*

Owner Occupied

Tenant Occupied

Second Residence

Vacant Building

Student Housing

Is property rented out sometimes?

Yes

Is property located within*

City

Rural

Mountain

Is the property located on 5 or more acres?*

Yes

Year Built*

Square Feet*

Number of Stories*

One

Two

Three

Would you like to be quoted for earthquake insurance?*

Yes

Cripple Wall

Yes

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

Porch Square Feet

Patios*

Yes

Patio Square Feet

Breezeways*

Yes

Breezeway Square Feet

Are there bars on the windows?*

Yes

Do the bars have quick release?*

Yes

Swimming Pool*

Yes

Lights strung over the pool?

Yes

Is Pool Fenced?

Yes

Diving Board or Slide?

Yes

Trampoline?*

Yes

Safety netting?

Yes

Type of Cooling*

Central

Evaporative

Other

Type of Heating*

Central

Wall Furnace

Floor Furnace

Wood Stove

Other

How many Fireplaces?

Smoke Detectors?*

Yes

Are there animals on the property?*

Yes

What kinds of animals and how many?

If there are dogs, what breeds?

Have any of your animals injured someone?*

Yes

Any Business on Premise?*

Yes

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

Describe the structure

Solar Panels?

Yes

Do you currently have homeowners insurance?

Yes

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

Yes

Please Explain

Do you own other real estate?

Yes

Where is it located?

Street Address Address Line 2 City State Zip Code

How is it used?

Do you own any aircraft?

Yes

List all aircraft

Do you own any watercraft (personal or non-personal)?

Yes

List all watercraft (personal or non-personal)

Do you own other types of motor vehicles?

This includes ATVs, registered motor vehicles, or other powered vehicles you own.

Yes

List all other types of motor vehicles

Are there any uncorrected building code violations?*

Yes

Please describe

Finishing Comments

FPU Affiliation

Are you a student, alum, faculty member or employee of Fresno Pacific University?

Yes

Homeowners Quote

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

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