Earthquake Quote
General Information
Name
*
Address
City
State
Choose State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
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Hawaii
Idaho
Illinois
Indiana
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Phone
Fax
Email
*
How did you hear about us?
Quote Information
Type of home
*
Single Family Home
Duplex
Mobile Home
Manufactured / Modular Home
Condo
Renters Policy
Other
Please select your type of home.
Do you have a home policy in place now?
No
Yes. Please list contents amount from policy page: $
Occupancy
Owner Occupied
Rented / Non-Owner Occupied
2nd Home
Seasonal
Vacant
Is there any hill or slope within 50 feet of your home on any of the 4 sides?
No
Yes. Please appoximate the height of the hill, or depth of the slope downwards:
Year built?
Square feet?
# of Stories?
Roof Type
Composition shingle
Tile
Gravel
Wood
Other
Foundation
Concrete Slab
Raised (crawl space) (0-100%
)
Garage
Attached
Detached
Built-in (room over garage)
Carport
# of Cars
Any unique features of the home?
Yes, list:
No
Any existing earthquake damage?
Yes. Describe briefly:
No
Outdoor Pool/Jacuzzi?
Yes
No
Comments
Condos Only
Does your homeowner association have an earthquake policy in place?
Yes
No
Is the value of your condo greater than $135,000?
Yes
No
Is there underground or tuck under parking, meaning living space build over the parking space?
Yes
No
