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Insurance Products

Consumer

Specialty Homeowner and Dwelling Fire Quote

Enter and submit the information below and a U.S. Insurance Services representative will contact you promptly with a quote for your requested coverage.

Personal Info

First Name*    MI Last Name*
Address* Home Phone*
  Work Phone
City, State, Zip* Email*
How would you like us to contact you?   Email:    Phone:
Primary Residence:*
Highest level of Education:*
Occupation:*

Prior Policy

Have you had coverage during the past 12 months? * Yes  No Number of Prior Losses *
Policy Number Policy Expiration Date
Company Agency

Basic Information

Location Zip Code* Dwelling Value (excluding land value)*
Year Built* Is home located inside city limits?* Yes  No
Purchase Date* Purchase Price*
Square Footage* Primary Heating Source*
Distance from fire hydrant (in feet) Protection Class
If vacant, is this a manufactured home? Yes  No Occupancy*
Number of Families Type of Construction*
Style of Home* Product*
Roof Type* Foundation Type*
Number of Baths* Garages & Carports - number of cars*

Basic Coverages

DP-1 Fire and Extended Coverage Personal property
Personal Liability Include Medical Payments?
Yes  No

Miscellaneous Coverages

Additional living expenses Fair rental value
Other structures Other Structures exclusion
Yes  No
Residence Burglary Vandalism & Malicious Mischief
Animal Liability exclusion Yes  No

Other

Supplemental Heating Device?
Yes  No 		Have you filed for Bankruptcy in the past 5 years?
Yes  No
Does the dwelling contain an automatic sprinkler system? Yes  No