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Annuities, Life Insurance, Long Term Care experts!   HOME QUOTE- EZ FORM- PLEASE FILL OUT BELOW The field marked with (*) are required fields. * Year Home was built? (Approximate) * How many stories? [Select One]1 Story1.52 Story2.53 Story * Style of Home? [Select One]RanchColonial (2 Story)CondoDuplexTownhomeSplit LevelBungalowOther * Square Feet (Approximate) * Basement? [Select One]YesNo If Yes Basement- Is it finished? [Select One]YesNo * Construction of Home? [Select One]BrickFrame * What are the outside walls? [Select One]BrickMix of Brick & SidingWood SidingAluminum SidingVinyl SidingStoneOther * Number of Bathrooms? [Select One]11.522.53 4 or more * Number of Fireplaces? [Select One]None123 * Garage? [Select One]NoneAttatched 1 CarAttatched 2 CarAttatched 3 CarDetatched 1 carDetatched 2 Carother Any additional features that would add value to Home? (Ex. WetBar, Hot-Tub, Central Stereo System, & etc) * How old is roof? (Has it been updated?) [Select One]1-20 years Old20-25 years Old25+ years * How old is Furnace? [Select One]1-25 Years Old25+ Years Old * Do you have a woodburning stove? [Select One]YesNo * Do you have a pool? [Select One]YesNo * Any Pets? If yes-please list type & breed. * Safety Discount: Distance to Fire Hydrant? [Select One]500 feet1000 feet2000 feetMore than 2000 feet * Distance to Fire Station? [Select One]1 Mile2-5 Miles6-8 Miles9 MilesMore than 9 Miles * Safety Discount? Do you have dead-bolt locks, smoke detectors, a fire extinguisher? [Select One]YesNo Safety Discount- Do you have a current security system? (ADT, BRINKS, & ETC) [Select One]YesNo * Current insurance company? * When does your Home Insurance Expire? (Month/Day/Year) What is your current insurance premium? ($) Insurance- What is your home currently insured for? (Dwelling-Example $152,000) $: What is your liability limit? [Select One]$100,000$300,000$500,000Other * Deductible? [Select One]$100$250$500$1000Other Do you have Water/Sewer Back-Up Coverage? [Select One]YesNo Do you schedule any personal property? Example Jewelry, Furs, Art? (If yes, give description & amounts) * Contact Info: Name (Include First & Last Name) * Date of birth (Month-Day-Year) Spouses Name (If Married) Spouses- Date of Birth (Month-Day-Year) * Street Address * City & State * Zip Code * Home Phone Work and/or Cell Phone E-mail Promo-code (If available)