Homeowners Quote

Online Quotes- Auto Homeowners Watercraft Life Services- Auto Claim Homeowners Claim Certificate of Insurance Request Info Questionnaire Our Website- Home Page About Us Contact Us Other- News Sports Weather

Homeowners Quote

Fill out the form below to obtain a customized homeowners quote. All red fields are required. Be careful to include this information before submitting your form.

Applicant Information

Name:

Street Address:

City/State/Zip:

/ /

Home Phone:

Work Phone:

Email:

Property Information

Property
Address:

Street :

City/State/Zip:

/ /

Construction Type:

Year Built:

"yyyy"

Square Footage:

sq. ft.

# Rooms:

# Apartments:

Market Value:

Replacement Cost:

Structure Type:

# Families

# Household Residents:

Is any resident a smoker?:

Purchase Date:

"mm/dd/yyyy"

Purchase Price:

Distance to Hydrant:

ft.

Distance to Fire Station:

mi.

Wired Alarm Systems
(connections to fire/police authorities):

Fire Alarm?: yes/no

Burglar Alarm?: yes/no

Fuel:

Gas

Oil

If "Oil" is checked, "Storage Tank Location" below is required.

Storage Tank Location
(ex. "basement"):

Electric

Wood

Coal

Solar

Please enter Year of Renovation, if applicable, for the items at right.

Electrical:

yyyy

Plumbing:

yyyy

Heating:

yyyy

Roof:

yyyy

Exterior Painted:

yyyy

Occupied By:

Please check those which apply:

Deadbolt

Smoke Detector

Fire Extinguisher

Property Visible to Neighbors

Swimming Pool?:

Yes

Approved Fence

Diving Board

Above Ground

In-Ground

Roof Type:

ex. "shingle"

General Information

Please check those which apply.

At Home Business:

Description:

Hazard present for flooding, brush fire, forest fire, landslide:

Description:

Animals/Pets:

Description/Breeds:

Property located within 2 miles of tidal water:

Description:

Property located on more than 5 acres:

Description:

Trampoline on Premises:

Yes

Rooms, Attics and Garages

Please enter the quantity of each type of unit in your home.
	Kitchen
	Dining Room
	Living Room
	Den/Study/Office
	Family/Recreation Room
	Bedroom(s)
	Bathrooms(s)
	Large Utility/Laundry/Sewing Rooms (Over 150 sq. ft.)
	Finished Basement (Omit if counted as family/rec room)
	Attached 2-Car Garage
	Large Finished Attic (Over 150 sq. ft.)
	Partially Finished Attic
	Partially Finished Basement
	Brick/Stone Exterior Walls
	Central A/C
	Aluminum/Vinyl Siding
	Large Wall Fireplace
	Enclosed Porch/Breezeway
	Clay Tile or Slate Roof
	Any Other Unit Not Listed Here

	Half Bath
	Large Open Porch/Breezeway
	Standard Fireplace
	Unfinished Basement
	Attached 1-Car Garage
	Built-in 2-Car Garage/Carport
	Small Utility/Laundry Sewing Rooms (Under 150 sq. ft.)
	Foyer/Entrance Hall
	Dressing Room/Walk-in Closet
	Unfinished Attic
	Small Finished Attic (Less than 150 sq. ft.)
	Mudroom (With separate entrance)
	Brick/Stone Veneer (Front Wall)
	Dinette or Partitioned Breakfast Nook
	Any Other Unit Not Listed Here

Thank You!
You've completed the form. Be sure you've answered all RED fields. If you have any general questions or comments, please enter them in the box below, then click the submit button. Thank you for considering Corkin Insurance. We will respond to you promptly.

General Questions/Comments: