Home Insurance Quote Information:
General Information
Applicant Name:
Date of Birth:
City & Zipcode: , KY
Retype Email:
Co-Applicant Name:
Marital Status: Single Married
Property Information:
Dwelling Type:
Construction Class:
Year Built
Square Footage:
Any Protective Devices (alarm)?
What type of Roof?
What type of Heat?
Is it on slab or basement? Slab Basement
Any losses in the past 5 years? Yes No
If so what were they and what dates did they occur? (This is important because it will show up on choice point and will change the price of the quote so it is better to have this info up front).
Coverage: (Questions that your Strong Insurance Agent will ask when they call)

How much coverage do you want on dwelling and personal property?

Any endorsements they want to add to policy?

Who is the current insurance carrier and policy number?

Name, Address and Loan number of Lien Holder?

What is the Applicant's social security number?