Quotez.me Home Insurance Quote

Quotez.me Home Insurance Quote Form
Applicant Information
Full Name

First NameLast Name
E-mail*
Phone Number

Area CodePhone Number
Is there a Co-Applicant?*

YesNo
Co-Applicant Information
Full Name

First NameLast Name
E-mail*
Phone Number

Area CodePhone Number
Additional Policy Information
Does this home have a mortgage or any other financial or non-financial additional interest? (Choose 'No' only if you have verified there are no interests of any kind.)

YesNo

Address
Mailing Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is your mailing address the same as your location address. Or in other words the same as the location address you want to insure?*

YesNo
Location Address

(The place you want to insure.)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

History Verification
Has property insurance been cancelled, declined or non-renewed in the last 5 years?

YesNo
Number of losses incurred in the last 5 years to the insured's home or personal possessions at this or another location

Applicant

(A Little More Background Information)
Full Legal Name

First & Middle NameLast Name
Birth Date
(MM/DD/YYYY)
Marital Status
Business/Industry
Occupation

Co-Applicant

(A Little More Background Information)
Full Legal Name

First & Middle NameLast Name
Birth Date
(MM/DD/YYYY)
Marital Status
Business/Industry
Occupation

Dwelling Information

(Home Information, The Actual Building and Structure)
Is this a secondary dwelling?

YesNo
Year Originally Built
(YYYY)
Construction Style
Dwelling Type
Roof Material
Heating
Exterior Walls
Foundation Type

Total Living Area
(In Square Feet)
Maintenance Condition
Total Number of Baths
Full Bath (s)
3/4 Bath (s)

1/2 Bath (s)
Fire Protection District
Discounts & Surcharges
Fire Sprinkler
Burglar Alarm Type

Cost Guide Features

This area may look complicated but do your best!
Hint: Some questions may be repeats. Also, if you already know
how much coverage you will need for your home you may skip
this section.
Skip to Coverage section?

YesNo

Exterior Features
Foundation Type
Percent
Slope?
Describe the land the foundation is built on
Percent
Roof Material
Percent
Garages & Carports
# Of
Attached Structures
Sq. Ft.

Interior Features
Kitchens
# Of
Bath
# Of
Fireplaces
# Of
Heating
Percent
Air Conditioning
Percent

Floor Finishes 1
Percent
Does your place have more than 1 floor finish?

YesNo
Floor Finishes 2
(If more than one type throughout the house)
Percent
Does your place have more than 2 floor finishes?

YesNo

Floor Finishes 3
(If more than two types throughout the house)
Percent
Does your place have more than 3 floor finishes?

YesNo
Floor Finishes 4
(If more than three types throughout the house)
Percent

Wall Finishes 1
Percent
Does your place have more than 1 wall finish?

YesNo
Wall Finishes 2
(If more than one type throughout the house)
Percent
Does your place have more than 2 wall finishes?

YesNo

Wall Finishes 3
(If more than two types throughout the house)
Percent
Does your place have more than 3 wall finishes?

YesNo
Wall Finishes 4
(If more than three types throughout the house)
Percent

Ceiling Finish 1
Percent
Does your place have more than 1 one ceiling finish?

YesNo
Ceiling Finish 2
(If more than one type throughout the house)
Percent

Special Features 1
# Of
Add another special feature?

YesNo
Special Features 2
# Of
Add another special feature?

YesNo

Special Features 3
# Of
Add another special feature?

YesNo
Special Features 4
# Of
Add another special feature?

YesNo
Special Features 5
# Of

Coverage Selection
Deductibles

(And Section I Property Coverages)
All Perils Deductible
Coverage A - Dwelling
(In dollars)
Coverage B - Other Structures
(In dollars)
Coverage C - Personal Property
(In dollars)
Coverage D - Loss of Use
(In months, standard is 24)

Section II - Liability Coverages
Coverage E - Personal Liability
Coverage F - Medical Payments to Others

Optional Coverages
G - Unscheduled Jewelry, Furs and Fine Arts
H - Unscheduled Silverware
I - Unscheduled Business Property

J - Business Merchandise
YY - Escape of Water from Sump or Drain
Scheduled Personal Property Items?

YesNo

Notes
Anything else you would like to include in your quote?
You are done, you Rockstar!

Please click Submit now.
By clicking submit I authorize the Ryan Hayes Insurance Brokerage (Lic #0E98806 CA, NV, AZ )or their agents to contact me using this information to provide quotes where permitted by law. I understand that for the purposes of the National Do Not Call registry, this constitutes an existing business relationship, allowing this website and its partners to contact me for up to 90 days after this request. Insurance brokers may confirm my information through the use of a consumer report, which may include a driving record, of which I authorize this website and its partners to obtain. I have read and understand the privacy policy of this website.
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