Log Homes Insurance Non-binding Quote Form
Fill out the information below required for a no obligation estimated insurance rate. Take a moment to contact our office by filling out the form and click the submit button. There is no charge for a quote.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Spouse/Significant Other
First Name
Last Name
Spouse/Significant Other Date of Birth:
-
Month
-
Day
Year
Date
Effective Date for Policy:
-
Month
-
Day
Year
Date
Is this a Dwelling or NBR (New Builders Risk)?:
Dwelling
NBR
Is the home inside or outside city limits?:
Inside city limits
Outside city limits
Location Address *Please include county as well*:
Address to house/property inquiring to insure. (Address, city, state, zip, county)
Current Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Home was Built:
Primary or Secondary Residence:
Primary Residence
Secondary Resicence
Exterior Material of Home:
Roof Type and Age:
Foundation Type:
Example: Concrete Slab, Block, etc.
Living Area Square Feet:
Number of Stories:
Garage (Yes/No): If yes, is it attached or detached, and number of cars
Basement (Yes/No): If yes, include Sqft / Finished Out?
Any Porches (Yes/No): If yes, total sqft and are porches covered or open?
Any Other Structures: If so, please list: Type, Size, Roof, Foundation, and Value of Structures.
Does the home have a fireplace and/or wood-stove?:
Fireplace
Wood-stove
Both
Any Swimming Pool/s (Yes/No): If yes, is there a locked fence around it or property?
Any Dogs (Yes/No): If yes, list the number and breed/s.
Any Livestock?:
Lot Size or Number of Acres:
Distance to the nearest secondary water supply:
(ex. lake/pond/hydrant/river)
Monitored by Alarm (yes/no): If yes, what type of alarm system.
If the home is over 30 years old are there any updates to the plumbing or wiring?:
Coverage Value and Replacement Cost:
Personal Property (Estimated amount or %):
Liability Coverage:
Any Loss History / Claims:
Current Carrier / Expiration Date:
Payment Type (Direct or Escrow?):
Tell us a little more about your home/property. List any additional information/comments that may be relevant to the house/property to be insured.
How did you hear about us?:
Submit
Should be Empty: