HOMEOWNERS INSURANCE IN A BRUSH AREA

If your home is located in a brush area, please use this form.

(click here for Condo insurance HO-6)

(click here for Renters insurance HO-4)

ABOUT THE HOME OWNER
First Name:
Last Name:
Location Address:
City:      
State:
Zip Code:
Phone:  
Birthday:
E-mail:
Confirm E-mail:
Status Single   Married  Widowed
   
Social Sec Num (Not for CA, for accurate quote, otherwise estimate)  
If you are a resident of A STATE OTHER THAN CALIFORNIA, prior address is required if you have not been at your current address for at least 3 years please provide your previous address in the boxes below.
 

ABOUT YOUR HOME
Year Built:   Size (in sq feet):
Year Purchased:  
Number of Bedrooms:         Bathrooms     Garages
Stories:  
Structure Coverage:  $
Roof Type:   
Age of Roof:
Attached:
Liability Limits:  $100k $300k$500k

If you need more liability insurance, we can obtain an umbrella policy quote from $500,000 to $5 million.
Extra Personal Property Coverage: $

(optional, beyond the already included portion)
   
Usage:
Other: Do you have a pet?  

If yes, choose amount of anima liability coverage:

  Prior losses or claims? Woodburning Stove
  Swimming Pool?           Trampoline?
Electrical:
  Is the dwelling within 500 feet of native brush, or isolated or inaccessible to fire fighting equipment?

Yes     No

   
  Do you currently have insurance (if yes, with what carrier? 
  What is your current yearly or monthly premium?
 
   
  Do you have any other information about your rental or apartment, or comments that you would like to share? Please place special requests here, such as extra coverage for special items.
 

         

 

NO COVERAGE IS BOUND, OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT INSURANCE.
 
 

 

 

 
If you have a current policy, it is often helpful to fax us a copy, so that we may compare coverages. Our fax number is (949) 270-0608.

 
If you are not sure of exactly what you need, make sure to at least give us a description of your home and we will send you a base quote that we can later adjust to find what is right for you.

 

 

 

As independent insurance agents, we can compare quotes from different insurance carriers to help you find a competitive rate. 

 

Why choose us as your broker?

 

 

Need help?

(949) 270-0609

 

 

Copyright 2010 Stratum Insurance Agency, LLC