Home Insurance Quote Request
Primary Applicant Information
Legal Name
*
First Name
Last Name
Property Address (to be insured)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a mailing address that is different from the above property address?
*
Yes
No
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Marital Status
*
Single
Married
Divorced
Domestic Partner
Widowed
Driver's License Number
*
Driver's License State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Industry and Occupation
*
Highest Education Obtained
*
No Highschool Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associates Degree
Bachelors Degree
Masters
PhD
Medical Degree
Law Degree
Have you been at your current residence less than 3 years?
*
Yes
No
Previous Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Secondary Applicant Information (Spouse or Domestic Partner)
Legal Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Drivers License Number
*
Driver's License State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Highest Education Obtained
*
No Highschool Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associates Degree
Bachelors Degree
Masters
PhD
Medical Degree
Law Degree
Industry and Occupation
*
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Existing Policy Information
Starting date for new home policy?
*
-
Month
-
Day
Year
Date
Do you currently have a homeowner's policy?
*
Yes
No
Reason for not having homeowner's policy
*
Please Select
First Time Homebuyer
Has Been Renting
Prior Insurance through Parent/Spouse/Other
Could Not Obtain Insurance
Self-Insured
Current insurance carrier
*
Years with current insurance carrier
*
Expiration Date of Current Policy
-
Month
-
Day
Year
Date
Years of continuous home coverage without lapse in coverage
*
Has any prior home policy been cancelled, declined, or non-renewed in the last 5 years?
*
Yes
No
If available, please upload the declaration pages of your current policy...
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you plan on bundling with an auto policy for an additional discount?
*
Yes
No
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General Home Information
Year Built (YYYY)
*
Purchase Date (MM-YYYY)
*
Home Usage
*
Please Select
-Primary Residence
-Primary Residence with occasional short term rentals
-Primary Residence with section of home currently rented
-Secondary Residence
-Seasonal Residence
-Rental
Is the residence vacant?
*
Yes
No
Number of occupants (including children)?
*
Please Select
1
2
3
4
5
6
7
8
Is there a business or daycare on the premises?
*
Yes
No
Do you have an HOA?
*
Yes
No
Do you have any dogs living with you?
*
Yes
No
How many dogs on premises?
*
What breed of dogs?
*
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Home Information - Amenities & Features
Which safety features are on the premises? Check all that apply.
*
Smoke Detectors
Dead Bolts on Doors
Fire Extinguisher
Indoor Sprinkler System
Alarm System (with 3rd party monitoring service)
Smart Home
None
Which option(s) best describes your foundation? Check all that apply.
*
Full Unfinished Basement
Full Finished Basement
Half/Partial Unfinished Basement
Half/Partial Finished Basement
Crawlspace
Slab
Walkout Basement
Do you have solar panels on roof?
*
Yes
No
Primary Heating Type
*
Please Select
Electric Baseboard
Gas - Forced Air
Gas - Hot Water
Oil - Forced Air
Oil - Hot Water
Radiant/Floor Heat
Other
Number of Wood Burning Stoves
*
Please Select
0
1
2
3
Are there any of the following amenities on the premises? Check all that apply
*
Trampoline
Inground Pool
Above Ground Pool
Inground Hot Tub
Above Ground Hot Tub
Diving Board
Pool Slide
Wet Bar
Central Vacuum
Home Theater
None
What is the pool depth under diving board (feet)?
*
Is there a safety net on the trampoline?
*
Yes
No
Do you have any patios, porches, or decks attached to the home?
*
None
Yes, open patio/porch/deck
Yes, enclosed patio/porch/deck
Yes, covered patio/porch/deck
Total square feet of patios/porches/or decks (approximate)?
*
Does your home have any of the following window or door types? Select all that apply
*
Bay Windows
Picture Windows (a large window consisting of one pane of glass, can't be opened)
Skylights
Sliding Doors
French Doors
None
Bay Windows (count)
*
Picture Windows (count)
*
Skylights (count)
*
Sliding Doors (count)
*
French Doors (count)
*
List any detached structures on your property (shed, garage, pergola, playground, etc.)
Full Baths (count)
*
3/4 Baths (count)
*
1/2 Baths (count)
*
What type of flooring in home. Check all that apply.
*
Carpet
Hardwood
Vinyl
Ceramic Tile
Laminate
Other
What percentage of your flooring is carpet (approx.)
*
What percentage of your flooring is hardwood (approx.)
*
What percentage of your flooring is vinyl (approx.)
*
What percentage of your flooring is ceramic tile (approx.)
*
What percentage of your flooring is laminate (approx.)
*
What percentage of your flooring is other (approx.)
*
Cooling System
*
None
A/C
Swamp Cooler
Does your A/C system use the same ducts as your heating system?
*
Yes
No
Fireplaces (count)
*
Type of Fireplace. Check all that apply.
*
Gas
Wood
Chimneys (count)
*
Other special features/comments?
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Home Information - Updates
Providing details on the updates to your home can significantly reduce your premiums.
Have any plumbing updates been made to the house since it was built?
*
Water heater replacement
New pipes installed
None
Year of most recent plumbing update?
*
Plumbing Pipes Material
*
Please Select
Copper
PVC
Pex Pipe
Unknown
Year heater/furnace was last installed or replaced?
*
When was furnace last serviced?
*
Have any electric and wiring updates been made to the house since it was built?
*
New boxes
New wiring
New Outlets
None
Year of most recent electric and wiring updates?
*
Does your house have circuit breakers?
*
Yes
No
Does your house have fuses?
*
Yes
No
Any knob and tube wiring?
*
Yes
No
Unknown
Number of Amps
*
Please Select
Under 100
100
150
200+
Unknown
Age of roof?
*
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Insurance Coverages (Optional)
Do you need additional coverage on any of the following items? Check all that apply.
Jewelry
Art
Firearms
Other
How much jewelry coverage do you need ($)
How much art coverage do you need ($)
How much firearms coverage do you need ($)
How much other coverage do you need ($)
Do you need flood insurance?
Yes
No
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Do you authorize Foundation Insurance Group LLC to proceed with providing quotes?
*
Please Select
Yes
No
You're all set! Click on the "Submit Quote Request" button to complete.
Submit Quote Request
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