Agent Info:
Name : Victoria Adgett
License ID : 3659421
Phone : (775) 800-9545
Email : [email protected]
Address : 3115 Knight Road, Reno, Nevada, 89509

Homeowners/Renters/Condo

  • Applicant
  • Home
  • Property
  • Carrier
  • Loss
  • Coverage
  • Finish

Applicant

Can you tell us about yourself?

First Name *
Last Name *
Date of Birth *
Marital Status

Where should we send your quote?

Email *
Phone *

What is your Occupation or Educational degree

(Discounts may apply)

Education Level
Industry /​ Occupation *
Specify (Industry/​Occupation) *
School Name *
School Address
Address *
City *
State *
Zip Code *
Company Name *
Company Address
Address *
City *
State *
Zip Code *

Please fill all the mandatory questions.

Home

Home Address

Address *
City *
State *
Zip Code *

Mailing Address

Address *
City *
State *
Zip Code *

Please fill all the mandatory questions.

Property

Policy

Policy Type *
The name of the ownership or (title) of the property *
Occupancy Type *

Construction of the Home

Type of Construction *
How many square feet is your dwelling *
What is your type of roof?
Other Roof type
Year of construction?
How is the quality of your home
Percentage of the house that is complete?

Pet Details

Type of Pet
Specify Pet
Breed of Pet

Protection

How close are you to the brush area?
Percent of Protection that is sprinklers
Do you have any protection for Burglar?

History

Year Wiring/​Electrical was Renovated *
Year Plumbing was Renovated *
Year Heating was Renovated *
Year Roofing was Renovated *

Please fill all the mandatory questions.

Carrier

Date of closing the Escrow
Please explain the reason not carrying an insurance

Please tell us about your current insurance

Home Insurance
Current Home Insurance Carrier *
Enter Other Home Carrier Name *
Current Home Insurance Expiration Date *
Current Premium
Current Auto Insurance Carrier
Enter Other Auto Carrier Name *
Are you being cancelled or non-renewed? *
What is the Reason?

Please fill all the mandatory questions.

Loss

Loss 1

Loss / Claim details
Type of loss *
Date of loss *
Amount of Loss
Description of loss

Please fill all the mandatory questions.

Coverage

What are your coverage limits?

What is your current dwelling limit *
What is your Liability Limit ? *
Coverage for Interior Walls *
Coverage for Personal Property

Collectible 1

Collectible

Type of Collectible
Specific Collectible
Insurance Value of Collectible

Additionals

Please fill all the mandatory questions.



Your details has been submitted successfully.




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