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Secondary Insurance Quote

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
- No
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
- No
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
- No
Name
First Last
Date of Birth
MM slash DD slash YYYY
Relationship
Do you have another person to add?
- Yes
- No
Name
First Last
Date of Birth
MM slash DD slash YYYY
Relationship
Do you have another person to add?
- Yes
- No
Additional Names, Dates of Births, and Relationship
Losses in five years?*
- Yes
- No
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
- No
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
- No
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
- No
Is property located within*
- City
- Rural
- Mountain
Is the property located on 5 or more acres?*
- 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
Are there bars on the windows?*
- Yes
- No
Do the bars have quick release?*
- Yes
- No
Swimming Pool*
- Yes
- No
Lights strung over the pool?
- Yes
- No
Is Pool Fenced?
- Yes
- No
Diving Board or Slide?
- Yes
- No
Trampoline?*
- Yes
- No
Safety netting?
- Yes
- No

Type of Cooling*
- Central
- Evaporative
- Other
Type of Heating*
- Central
- Wall Furnace
- Floor Furnace
- Wood Stove
- Other
How many Fireplaces?
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
Do you own other real estate?
- Yes
- No
Where is it located?
Street Address Address Line 2 City State Zip Code
How is it used?
Do you own any aircraft?
- Yes
- No
List all aircraft
Do you own any watercraft (personal or non-personal)?
- Yes
- No
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
- No
List all other types of motor vehicles
Are there any uncorrected building code violations?*
- Yes
- No
Please describe
Finishing Comments
FPU Affiliation
Are you a student, alum, faculty member or employee of Fresno Pacific University?
- Yes
- No
Email
This field is for validation purposes and should be left unchanged.

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

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Homeowners Quote

Step 1 of 3

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

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