Secondary Insurance Quote Homeowners Quote Step 1 of 3 33% Tracking The state where you need insurance coverage*CaliforniaOregonWashingtonAnother StateUnfortunately, 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 CaliforniaArizonaWashingtonOregon State Zip Code Is Billing Address the same as Physical Address? Yes No Billing Address Street Address Address Line 2 City CaliforniaArizonaWashingtonOregon 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 premisesName 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 RelationshipLosses in five years?* Yes No Please ExplainFor 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 CarsPorches* 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 CaliforniaArizonaWashingtonOregon 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 CommentsPhoneThis field is for validation purposes and should be left unchanged.