Homeowners

1
Let’s start with your name.
First Name
Last Name
2
Date of birth
DOB
Month
Day
Year
3
What’s your home address?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Is it your primary residence?
YESNO
5
Do you rent or own it?
RENT
OWN
6
Year purchased
Date
Month
Day
Year
7
Are you closing on a new home or just thinking of switching insurers?
I’m closing on a new home
I’m thinking of switching
Other
8
What type of property is it?
Detached Home
Semi-attached
Townhouse
Condo
Co-op
Multi-unit
9
What type of building is it?
Single family
Duplex
Triplex/Fourplex
10
Number of storiesFrom street level up. Do not include basement
1
2
3
4
11
Is there a basement?
YESNO
12
Is the basement finished?
YESNO
13
What is the square footage of your home?(Excluding all outdoor spaces such as porches,decks, and terraces)
Square Footage
14
Do you have a front porch or deck?
YESNO
15
Total square footage of outside porch/deck area
Square Footage
16
Who lives in your home?
It’s just myself
We’re a couple
Couple with children
My children and I
Other
17
How would you describe the condition of the Exterior & Interior?This helps us estimate reconstruction costs in case of damage.
Needs work
Standard
High
Superb
18
Type of construction
Frame
Joisted Masonry
Brick
Non-Combustible
Masonry Non-Combustible
Fire Resistive
I don't know...
19
Type of siding
Shingles
Vinyl
Wood Shake
Brick
Other
20
When was your house built?
Year
Year
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
21
How do you heat your home?
Gas
Oil
Other
22
Where is the tank located?
Above ground
Under ground
23
Age of boiler
Please Select
Please Select
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
24
Do you have a swimming pool?
YESNO
25
Is there a fence around the pool?
YESNO
26
Is there a diving board or a slide?
YESNO
27
Do you have a trampoline?
YESNO
28
Do you have a dog?
YESNO
29
What breed is/are the dog(s)?
30
Did your home undergo any substantial renovations? If so, when?By renovation, we mean a complete upgrade of your plumbing, heating, or electrical systems.
Year
Year
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
*Leave blank if no renovations or unknown
31
Please describe the type of work that was donePlease indicate type of work and year completed
Details about renovations
32
Do you have any of the following?
Fire alarm
Burglar alarm
33
Do you have a mortgage or loan on this property?
YESNO
34
What is the estimated value and current balance?
Estimated value
Current balance
35
What is the estimated home value?
Estimated value
36
If you’d like, we can match our coverage to your existing policy.This will help you compare apples to apples 😀
Sure, let’s do it
No need
37
Do you want to upload your current policy information or enter it manually?
Upload files, pics, etc...
Enter information manually
38
Upload a copy of your existing policy so we may review and compareYou can upload most file types, including screenshots!
Drag and drop files here
Select files to upload
Cancelof
39
Please enter your current policy informationPlease enter as much information as possible to help us provide an accurate quote
Current insurance provider
# of years with current carrier
Current annual premium
40
Did you file any home or property claim within the past 5 years?
Nope
Only one
More than one
41
Alright! Let’s get you a quote.Please enter the information below so we may contact you and provide you with your quote details.
Please enter your email
Please enter your phone
Morning (8-12)
Afternoon (12-5)
Evening (5-9)
Best time to call
Should be Empty:

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.