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ABOUT YOUR HOME |
| Year Built: |
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Size (in sq feet):
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| Year Purchased: |
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| Number of Bedrooms: |
Bathrooms
Garages
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Stories: |
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| Dwelling
Coverage: |
$
- feel free to call us with questions |
| Roof Type: |
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Age of Roof: |
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Attached: |
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| Liability Limits: |
$100k
$300k$500k
If you need more
liability insurance, we can quote an umbrella policy quote from
$500,000 to $5 million. |
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| Usage: |
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| Other: |
Do
you have a pet?
If yes, choose amount of animal
liability coverage:
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Prior
losses or claims?
Woodburning Stove / Pellet Stove |
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Swimming
Pool?
Trampoline? |
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Electrical:
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Is the dwelling within 500 feet of
native brush, or isolated or inaccessible to fire fighting
equipment?
Yes
No
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Do you currently have insurance (if
yes, with what carrier?
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What is your current yearly or
monthly premium? |
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| Other Coverages: |
Golf Cart?
Add a Watercraft (tell us more below)?
Add a Snowmobile (tell us more below)?
Add Jewelry (tell us more below)?
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Do you have any other information
about your property or apartment, or comments that you would like to
share? Please place special requests here, such as extra coverage
for special items.
If
you have any claims, let us know here. |
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Copyright 2017 Stratum
Insurance Agency, LLC |
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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. |