HOME OWNERS INSURANCE QUOTE

Oswald Insurance will provide a quotation based on the information provide us. The more precise, the better. Information submitted will be confidential.  

Fields marked with an asterisk * are required.

CONTACT INFORMATION
Your First Name:  *
How would you prefer to be contacted regarding your quote? Email Phone Fax*
Email address: 
Fax Number:
Phone Number:
Best time to call:
Morning Afternoon Evening
Your Age: 

STRUCTURAL INFORMATION
How many stories is your home?
What is the total square footage of the living area of your home?
Basement? Yes No
Garage:

HOW MANY OF THE FOLLOWING DO YOU HAVE IN YOUR HOME
Full bathrooms:
Half bathrooms:
Fireplaces:

LOCATION INFORMATION
Is your home inside city limits? Yes No
Zip code:
Within 1000 feet of a fire hydrant? Yes No
Within 5 miles of the fire station? Yes No
Close to a body of water or susceptible to flooding? Yes No

GENERAL QUESTIONS
Year home was built:
Heating and Cooling system: Yes No
Heating system only: Yes No
How would you describe your kitchen?
Is business conducted on the premises?   Yes No
Does anyone in your home smoke? Yes No
Did you experience any loss or claims in the last 5 years? Yes No

Please describe any loses or claims

PROTECTIVE DEVICES
Burglar alarm?
Smoke detectors? Yes No
Fire extinguishers? Yes No
Fire alarm?
Deadbolt locks? Yes No

ADDITIONAL DATA
Would you like a quote on a personal liability umbrella? Yes No
 

 

© 2005 by Oswald Insurance Agency. All Right Reserved.