Home Insurance Quote Information

Katechis Insurance Agency

Home Insurance Quote Form
Primary Name*

First NameLast Name
Date of Birth

MonthDayYear
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Spouse/Other Name If Applicable)

First NameLast Name
Date of Birth (If Applicable)

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please let me know what type of ownership this is*

OwnRented to othersVacantSecondary/Seasonal
Home Specifics

Please include as much information as possible, if there is additional info that you need to let me know about please email to christina@katechisinsurance.com
Year Built
Total Living Area Square Footage
Is your home a ranch/cape/colonial/split?
Is your home on a slab/crawlspace of basement?
If this is a basement, what percentage is finished?
How many bathrooms are there and are they full/half or 3/4
full (tub and shower combo ,sink and toilet half (sink and toilet only) 3/4 (stand up shower, sink and toilet.
Primary Heating Source? Gas/Electric/Oil
Has your electric/plumbing or heating been completely replaced?
Please provide any additional information on electrical amperage/fireplace(s)?
Has your roof been completely replaced? If so what year?
Garage/Carport - Please note the # of cars and type
Attached/built-in | Basement | Carport | Detached
Any attached features to your home?
Porches/Decks/Balconies/Breezeways/Patios
Do you have a centrally monitored alarm? Is it Burglar/Fire or Both?
Do you have a Pool/Trampoline/Dogs or is there any business conducted on the property
If you have any additional information to include please place that here.
How many claims have you had in the last 5 years?
For any claims that you have had please let use know the date/what happened and how much money was paid to have your home fixed as well as if the claim is completed (closed) or still being worked on (open).
Type a question*

GoogleFacebookTwitterInstagramNextdoorAdvertisementLinkedInPersonal referral (please enter the name in the box below!)Other
Who can I thank for referring you over?
Please feel free to upload a declarations page if you have access to it.

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Have a copy of your declarations page in front of you? Simply take a picture!
How easy was this form?*
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In connection with a quote for insurance, we may review your credit report or obtain or use a credit-based insurance score based on the information contained in that credit report. We may use a third party in connection with the development of your insurance score.

By clicking “SUBMIT” you agree to receive texts and calls to this number about products, services, marketing, surveys, and claims, including by automatic telephone dialing system or an artificial or prerecorded voice, from the Katechis Insurance Agency. Your consent is not a condition of purchase.
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Katechis Insurance Agency

Home Specifics