Source
State

Current Insurance

Are you currently insured?
If yes, with whom?
Residence Information
What type of dwelling are you insuring?
What is the total square footage of the dwelling?
How many stories are in your building?
How many bedrooms do you have?
How many bathrooms do you have?
Residence Features
What type of heat source do you use?
How is your building sided?
How far away from a fire station is your dwelling?
How far away from a fire hydrant is your dwelling?

Please check any of the following safety features that you have:

Burglar Alarm Dead Bolts Fire Alarm Fire Extinguishers
Manned Security Station Monitored Burglar Alarm Smoke Detectors Sprinkler System
Coverage Requested
How much insurance is needed on the contents (personal property) of your dwelling?
Requested amount of liability
  
Requested Deductible
Many companies use credit scores for rates and discounts. How would you honestly rate your credit history?
   
Claims History
How many homeowners or renters claims have you had in the last 5 years?