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YOU ARE HERE : Home / Get Quotes / Homeowners Insurance  Homeowners Insurance Personal Information Name: Address: City: State: FL NJ NY MD PA Zip: Email Address: Home Phone: Work Phone: Fax: Current Homeowners Insurance Information Current homeowner insurance carrier: Expiration date: How long with current carrier: Current automobile insurance carrier: Desired liability coverage: $100,000 $300,000 $500,000 $1,000,000 Select Current dwelling value: Year home was built: How long have you lived there: Type of home: Townhouse Rancher Split Foyer 2 Story Contemporary Custom Other Select Type construction: Brick / Stone Veneer Brick / Stone / Concrete Block Aliuminum / Vinyl / Asbestos Siding Frame Select Type of roof: Asphalt Wood Tile / Slate Fiberglass Tin Other Select Age of roof: Type of plumbing: Copper Galvenized PVC Select Age of plumbing: Type of electric: Circuit Breaker Fuse Select Age of electric: Type of heating: Gas Electric Oil Wood Coal Solar Other Select Age of heating: Options Sprinkler System Smoke Detectors Fire Alarm Connected to Monitoring Service Burglar Alarm Connected to Monitoring Service Fire Protection Distance to fire hydrant: Less than 1000 feet More than 1000 feet Select Distance to fire department: Less than 5 miles More than 5 miles Select Provide name of responding fire department: Note: Homeowners insurance does not cover floods. If you are interest in providing broader coverage to include insurance against floods please indicate so in the comments block below. Do you operate a business from your home? Yes No (If Yes, what type of business is it?) Do you have any pets? Yes No (If yes, please list type and breed) Have you submitted any claims in the past five years? Yes No If so, please describe (include date(s) of loss and amount(s) paid) Have you ever been refused, canceled, expired or non-renewed? Yes No Note: Many homeowner policies contain special limits of liability on items such as gold, silver, coins and other precious metals as well as jewelry, furs, silverware, pewter, firearms, watercrafts, fine arts, and business personal property. Arrangements to enhance your policy can be made to provide a much broader coverage. If you desire this coverage please indicate so in the comments block below. Do you have any special hobby or items that you would like specifically insured? Yes No (If yes, please list them here) Comments / Remarks