HOME INSURANCE Step 1 of 7 14% Are you a current client of Prominent Insurance?(Required) Yes, I'm a current client No, I'm a new client Name(Required) First Middle Last Suffix DATE OF BIRTH(Required) MM slash DD slash YYYY PhoneEmail ANY OTHER NAMED INSURED LIST HEREEXAMPLE - NAME - DOB I WANT TO INSURE(Required) HOME CONDO RENTERS Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code IS HOME CURRENTLY INSURED(Required) YES NO NEW PURCHASE IF HOME IS CURRENTLY INSURED WITH WHO EXAMPLE - PROGRESSIVE- TRAVELERS - SELECTIVEHOW MANY YEARS INSURED ( IF CURRENTLY INSURED ) CURRENT DWELLING COVERAGE / MARKET VALUE/ FOR RENTERS CONTENT COVERAGE(Required) EXAMPLE - HOW MUCH YOU PAY FOR HOME LIABILITY LIMIT DESIRED(Required) 100K 300K 500K 1M DEDUCTIBLE DESIRED 250 500 1000 2500 STYLE OF HOME(Required) EXAMPLE - COLONIAL - RANCHER- TOWNHOME SQUARE FEET OF HOME(Required) FOUNDATION TYPE(Required) SLAB BASEMENT CRAWL SPACE EXTERIOR TYPE(Required) FRAME MASONARY JOIST MASONARY TYPE OF ROOF(Required) PITCH ROOF / GABLE FLAT ROOF NUBMER OF FAMILES(Required) SINGLE FAMILY DUPLEX TRI-PLEX FOUR PLEX YEAR HOUSE WAS BUILT EXAMPLE 2022 WHAT YEAR WAS ROOF UPDATED(Required) EXAMPLE -2019WHAT YEAR WAS PLUMBING UPDATED(Required) EXAMPLE -2019WHAT YEAR WAS ELECTRICAL UPDATED(Required) EMAPLE- 2019WHAT YEAR WAS HEATING UPDATED(Required) EXAMPLE -2019 TYPE OF HEATING EXAMPLE - NATURAL GASCENTRAL AIR YES NO DO YOU HAVE DECK / PORCH IS SO SQUARE FEET EXAMPLE-125 SQ FEET NUMBER OF FIREPLACES NUMBER OF FULL BATHS(Required) NUMBER OF HALF BATHS(Required) HOW MANY MILES TO FIRE DEPARTMENT(Required) EXAMPLE- 5 MILESHOW MANY FEET TO FIRE HYDRANT(Required) EXAMPLE - 500 FEET DEAD BOLT LOCKS(Required) YES NO FIRE EXTINGUISHERS(Required) YES NO SMOKE DETECTORS(Required) YES NO CENTRAL FIRE ALARM(Required) YES NO CENTRAL BURGLAR ALARM(Required) YES NO TRAMPOLINE(Required) YES NO SKATEBOARD RAMP(Required) YES NO IN GROUND OIL TANK(Required) YES NO DO YOU HAVE DOGS(Required) YES NO IF YOU HAVE A DOG WHAT TYPEEXAMPLE - PIT BULL VALUE OF SPECIAL PROPERTYSUCH AS JEWERLY- FINE ART- OR EXPENSIVE COMPUTER EQUIPMENT
