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E-mail Address
What type of Property do you have Residential or Commercial?
Is Your Home a Mobil Home or a Manufacture Home?
The year Built?
Property Square feet?
What kind of Roof do you have?
How old is your Roof?
Do you have a Pool?
How many floor do you have?
How many Bedroom do you have?
How many Bathroom do you have?
How many Car Garage do you have?
Is Garage Attached or Detached to the House?
How many Fireplace do you have?
Do you have Trampoline?
Is any Smokers in the House?
Do you have Smoke Alarm?
Do you have any Alarm?
If you have Alarm is it Local or Central Alarm?
Do you have a dog? what type?
Do you need Dog Liability Insurance?
Do You need additional Umbrella Insurance?
Do You need additional Personal Injury Liability Insurance?
Are you in Flood area?
Are you in brush area?
Do You need additional Flood Insurance?
Are you on the Hillside?
Do You need additional Hillside Crash Insurance?
Do You need additional Earthquake Insurance?
Do you have Copper Pluming?
Is this a new Purchase?
Date of Purchase
What effective date do you want?
Did you had any Claim in the last 5 years?
If yes What is the date of Claims?
What type of Claim did you had?
How Much was the Claims for?
What is the name of your current insurance co.?
What is your Policy No.?
Comments
Do you have any other request or information we need to know?
WE INSURE ALMOST ALL KIND OF PROPERTIES, DO YOU HAVE ANY OTHER PROPERTY THAT YOU CAN NOT GET IT INSURED? ASK US WE MAY BE ABLE TO INSURE IT FOR YOU AT LOW COST.
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