HomeOwners Quote — INSURHAUS

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About us
- Overview
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Contact us
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HOMEOWNERS QUOTE FORM

We appreciate your interest in Homeowners Coverage! Please fill out this form and receive best proposal possible. Please take into mind that we represent your interest against Insurance Companies. Based on Your provided information the quote will be generated, more information you will provide, more accurate quote will be offered

Step 1 of 5

20%

Owners/Applicant Name*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Property Address (if Different from Mailing)
Street Address Address Line 2 City State ZIP Code
Phone*
Email
Date Coverage will start*
MM slash DD slash YYYY

Property Information
PROPERTY Not Owner Occupied
- if YES please check
Property Usage*
- House is for Rent
- House is my secondary house
- House is Vacant
Owner's Residency Address
Street Address City State ZIP Code
Existing House Values*
Buying Price $ Market Value $ Current Insurance Value $
Dwelling Dates*
Year Built Year Purchased
Square Footage of the House*

House Value Calculator
Filling out this part of form will help to define if your Insurance House Value calculated Correctly.
House Detailed Info*
Bedrooms # Full Bathrooms # Half Bathrooms # # of Cars Garage # of Fireplaces
# - Number/Amount
Basement*
Building Type
Construction Type
Roof Type
Heating type
Year Updates Made if Applicable
Year of Roof Year Wiring Year Heating

Underwriting questions
Is the property insured now*
Has the property had any losses in last 60 month*
Premises Specifics
- There is Pool on Premises
- There is Trampoline on Premises
- There are Exotic Animals on Premises
- Business Conducted on Premises
- There are Special Exposures on Premises
- I had Losses in This Premise in Last 5 Years
- I have existing Coverage
Specific Exposures on Premises. Please Specify
Losses during Last 5 Years
Date Description Amount of Loss $
Existing Policy Information
Please fill out this section, we can apply discounts because you were insured with certain Carrier.
Existing Policy Expiration Date
MM slash DD slash YYYY
# of Month with Current Carrier
Carrier
Existing Policy Premium

Coverages Required
I need following Coverages
- House Replacement Coverage limit (min 100%)
- Contents Replacement Coverage
- Sewer BackUp Coverage
- Scheduled Personal Property
- Earthquake Coverage
- Flood Coverage
Minimum Coverage Limits Required*
House Limit Personal Contents Limit Liability Limit Medical Payments
Scheduled Personal Property
Purchase Date Content Name /model Indentification Number Scheduled Value $
Payment options*

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