Kunevich & Lau Insurance Agency

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Homeowners Quote

Fill out the form below to obtain a customized homeowners quote. All red

fields are  required. Be careful to include this information before submitting your form.

 
Applicant Information
Name:
Street Address:
City/State/Zip: / /
Home Phone:
Work Phone:
Email:
Property Information
Property
Address:		 Street :
City/State/Zip: / /
Construction Type:
Year Built: "yyyy"
Market Value: $
Replacement Cost: $
Structure Type:
# Families
Purchase Date: "mm/dd/yyyy"
Purchase Price: $
Wired Alarm Systems
(connections to fire/police authorities):		 Fire Alarm?: yes/no
Burglar Alarm?: yes/no
Fuel: Gas

Oil


 		 If "Oil" is checked, "Storage Tank Location" below is required.

Storage Tank Location
(ex. "basement"):
Electric
Wood
Coal
Solar
Occupied By:
Please check those which apply: Deadbolt
Smoke Detector
Fire Extinguisher
Property Visible to Neighbors
Swimming Pool?: No
Yes Approved Fence
Diving Board
Above Ground
In-Ground
Roof Type: ex. "shingle"
General Information
Please check those which apply.
At Home Business:      Description:
Hazard present for flooding, brush fire, forest fire, landslide:      Description:
Animals/Pets: Description/Breeds:
Property located within 1000 feet of tidal water:      Description:
Property located on more than 5 acres:      Description:
Trampoline on Premises: Yes
No
Rooms, Attics and Garages
Please enter the quantity of each type of unit in your home.
Kitchen
Dining Room
Living Room
Den/Study/Office
Family/Recreation Room
Bedroom(s)
Bathrooms(s)
Large Utility/Laundry/Sewing Rooms (Over 150 sq. ft.)
Finished Basement (Omit if counted as family/rec room)
Attached 2-Car Garage
Large Finished Attic (Over 150 sq. ft.)
Partially Finished Attic
Partially Finished Basement
Brick/Stone Exterior Walls
Central A/C
Aluminum/Vinyl Siding
Large Wall Fireplace
Enclosed Porch/Breezeway
Clay Tile or Slate Roof
Any Other Unit Not Listed Here
 
Half Bath
Large Open Porch/Breezeway
Standard Fireplace
Unfinished Basement
Attached 1-Car Garage
Built-in 2-Car Garage/Carport
Small Utility/Laundry Sewing Rooms (Under 150 sq. ft.)
Foyer/Entrance Hall
Dressing Room/Walk-in Closet
Unfinished Attic
Small Finished Attic (Less than 150 sq. ft.)
Mudroom (With separate entrance)
Brick/Stone Veneer (Front Wall)
Dinette or Partitioned Breakfast Nook
Any Other Unit Not Listed Here
 
Thank You!
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We will respond to you promptly.

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