Homeowners Insurance
For California residents only.
Click the SUBMIT button to receive your free quote. Remember should you wish to speak to a live person you can always phone us at 888-MY-INS-GUY/888-694-6748 (M-F 8:00 - 5:00).
Customer Information
Name
E-mail
Street address
City
County
State
Zip Code
Home Phone
Work Phone
FAX
Address of Property (if different from above):
Address
City
County
State
ZipCode
Home Building Description
Number of families:
Age 55
& Retired
Inside City
Limits?
Year
Built
Central & Alarm Systems
(Select all that apply)
Yes
No
Yes
No
Smoke Alarms
Local Burglar Alarm
Fire Extinguisher
Central Station Burglar Alarm
Dead Bolts
Central Station Fire Alarm
Local Fire Alarm
Interior Sprinkler System
Vacuum System
Intercom - connects all rooms
More Property Information
Home Style
-- select --
1 story - Ranch
1.5 story - Cape
1.65 story - Bi-level
1.75 story - Tri-level
2 story - Colonial
2 story - Victorian Standard
2 story - Victorian Ornate
End Unit - Townhouse
Center Unit - Townhouse
Hillside Construction
-- select --
None
Low (15-29%)
Moderate (30-44%)
Steep (45-60%)
Type of Foundation
-- select --
Crawl Space (built prior to 1961)
Slab (built after 1961)
Basement (unfinished)
Basement (finished)
Garages:
1 Car
2 Cars
3+ Cars
Attached
Detached
Built-In
Carport
Kitchen:
-- select --
Standard Kitchen
Custom Kitchen
Deluxe Kitchen
Bathrooms:
-- select --
1 Bathroom
1 1/2 Bathrooms
1 3/4 Bathrooms
2 Bathrooms
2 1/2 Bathrooms
2 3/4 Bathrooms
3 Bathrooms
3 1/2 Bathrooms
3 3/4 Bathrooms
4 Bathrooms
Attached Porch:
-- select --
None
Small Open Porch
Medium Open Porch
Large Open Porch
Small Closed Porch
Medium Closed Porch
Large Closed Porch
Attached Wood Decks:
-- select --
None
Small Decks
Medium Decks
Large Decks
Small Custom Decks
Medium Custom Decks
Large Custom Decks
Greenhouse:
-- select --
None
Small Greenhouse
Medium Greenhouse
Large Greenhouse
Square Footage :
Finished Attic (%) :
Cathedral Ceiling (%) :
Breezeways:
Balconies:
Fireplaces:
Even More Property Information
Exterior Walls
(must equal 100%):
% Stucco on Frame
% Wood Siding
% Wood Shake
% Wood Shingle
% Clapboard
% Aluminum Siding
% Solid Brick
% Solid Stone
% Brick Veneer
% Concrete Block
% Stucco on Block
% Other (See Comments)
Interior Wall Coverings
(must equal 100%):
% Paint (only)
% Average Paper
% Ornate Paper
% Stone
% Mirrors
% Grass Paper
% Book Case
% Marble Tile
% Plywood Paneling
% Millwork
% Terrazzo
% Heavy Wood
% Knotty Pine
% Carpet
% Ceramic Tile
% Deluxe Tile
% Stucco
% Cork
% Brick
% Other (See Comments)
Flooring (must equal 100%):
% Hardwood
% Avg. Carpet on Hardwood
% Luxury Carpet/Hardwood
% Wall-Wall Carpet, Avg.
% Wall-Wall Carpet, Luxury
% Parquet
% Tile
% Deluxe Tile
% Vinyl
% Terrazzo
% Flagstone
% Slate
% Stone
% Brick
% Plank
% Marble
Roof:
-- select --
Asphalt/Fiberglass/Comp Shingles
Wood
Heavy Wood Shake
Tile (clay,concrete)
Tar & Gravel (built-up)
Slate
Other (See Comments)
Heating:
-- select --
Gas
Electric
Air Conditioning:
-- select --
None
A/C only
A/C Same ducts as heat
A/C Separate ducts
Requested Coverages
Home currently insured for:
(This is NOT the purchase price)
Liability
Deductible
Earthquake
Cov. Wanted?
-- select --
$100,000
$300,000
$500,000
$1,000,000
-- select --
$500
$1,000
$2,500
$5,000
Yes
No
Do you have any Jewelry, Fine Arts, Sporting Equipment or
Collections which may need special "ALL RISK" Coverage?
Underwriting Information
Current Insurance
Expiration Date
Breed of Dogs?
Losses within the
last 5 years?
Reporting Method
How would you like to receive
your free Homeowner Insurance quote?
U.S.Postal
E-mail
Fax
Home Page
|
Earthquake Info
|
E-Mail
Gary Jones Insurance Agency
CA License #0E22842
insure@iinsureit.com
508 Main Street
310-615-0940 Phone
888-MY-INS-GUY
El Segundo, CA 90245
310-615-0994 Fax
888-694-6748
