Homeowners Insurance Quote

Name

First NameLast Name

Birthdate

Date

Phone Number

Format: (000) 000-0000.

E-mail

example@example.com

Marital Status

Occupation Industry

Occupation Title

Is there a co-owner (additional name on deed. ex. Spouse)

Spouse/Co-Owner

First NameLast Name

Date

Relationship to you

Occupation Industry

Occupation Title

Is Property Address also Mailing Address?

Address

Street Address

Street Address Line 2

CityState

Zip Code

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Safety Features (select all that apply & give details below)

Is the property currently insured?

Reason for no current insurance

Current Insurance Carrier (or prior if policy is lapsed/cancelled)

Expiration/Cancellation Date of Current or Prior Insurance

Years with Current Insurance Carrier

Miles to nearest Fire Station

Feet to nearest Fire Hydrant

Year Home was Built

Electric circuit breaker present?

Square Footage of Home

Purchase Date/Closing Date

Type of Dwelling

If "other", please explain in "additional info" below

Dwelling use

How many people live at address?

Roof Type

Please Describe "other" Roof Type

Ex. Wood Shake

Age of roof in years

Enter "0" if less than 1 year

Foundation type

Garage type

Detached Structures (please list all)

Please give dimensions of structures in feet ex. 20x30

Number of full bathrooms

Number of half bathrooms

Primary heat source

Heating fuel type

Dwelling Coverage

Amount to replace home in total loss

Personal Property Coverage Limits

Please indicate higher percentage requested in "additional info" below

Deductible

Please indicate higher deductible requested in "additional info" below

Personal Liability Coverage Limits

Please indicate higher liability limits requested in "additional info" below

Medical payments to others

Please indicate higher medical payments limits requested in "additional info" below

Payment plan requested

Claims in last 5 years

If no claims, enter "0"

Give details of claims including date, type of loss, and amount paid by insurance.

Have any of the following been updated (check all that apply)

Give details of updates including the year update(s) were made.

(ex. Natural gas insert 2020)

Pool?

Pool area surrounded by 4ft+ high fence? Or above ground pool with lockable ladder?

Trampoline?

Anyone in the household smoke?

Is there any business or daycare on the premises

Please explain business operations below including if there is customer traffic on premises.

Daycare operations will require additional questions, but please include all info you consider relevant to operations.

Any aggressive breed animals, animals with a bite history, exotic animals, or farm animals?

List breed/type of animals and explain

Additional information (please include info for any questions above that require further explanation, otherwise it may affect if carriers offer you a quote or discounts)

Type "N/A" if no additional information applies

Most insurance companies use information provided by the customer and other sources, such as claims and credit histories, to calculate an accurate price for insurance. By clicking "Submit" to this form, you authorize Shoals Insurance Group to pull any necessary reports through the insurance companies in order to receive quotes on your behalf.