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ARG & Associates will provide you with a free, no-obligation Home and Earthquake Insurance quote. The information below is kept confidential. Please answer as many questions as possible, so we can provide you with the most accurate quote.

Condominium & Rental Insurance

Personal Information

Name:                        Date:

Address:

City:

State:

Zip:

Phone:                      Best time to call:   am    pm

E-mail:

Insurance Information

Currently Insured with:

Policy Number:            Policy Expiration Date:

Premium Amount: $       Insured Amount: $

Term of Insurance:  6 months    1 year    other:

Homes Information

How long have you had this address?

Year home was built:

How many claims in the past 3 years?

How many units in are in the building?

Homes Structure

Number of Story:  Single Story     1 &1/2 Story    2 Story    Split Level    Bi Level    other:

Structure:  Frame    Stucco    Veneer    Masonry    other:

Roof:  Asphalt Shingle    Wood Shingle    Tile or Slate    other:

How old is the roof?

Homes Feature

Number of Bedrooms:

Number of Bathrooms:     Number of Half Baths:

Does the Home have Central Heating  Yes    No;     What Type of Heater does the Home have?   Natural Gas    Propane    Electric    Oil    Wood    Solar    Other:

Does the Home have a Security System?  Yes    No, if Yes, is it  Monitored   Not Monitored

Does the Home have a Fire Alarm?  Yes    No, if Yes, is it  Monitored   Not Monitored

Does the Home have a Smoke Detector?  Yes    No

Additional Detail

Please list below any additional details in the space provided below:

When you click "Submit Quote" button, your application will be emailed to one of our representatives, who will contact you shortly.

      

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