5405 Chena Ave, #4
Anchorage, AK 99508

Phone: 907- 337-2311
Toll Free: 800-770-2311
Fax: 907-338-6344

 
   

 

 

 

Request a Quote - Home

Complete the following information. Upon review of the information we will contact you. If you have questions please Contact Us.
Instructions:
  1. Complete the form as thoroughly as possible
  2. Items marked with * are required
  3. The information you provide in this form will be used to prepare a quote for you
Contact Information:
Name: *
Mailing Address:
Street

City

State

Zip
Please provide an email address or phone number *
E-mail Address:
Daytime Phone:
Contact Method:  Please call me with quote premium.
 Please send quote via e-mail.

Type and Amount of insurance desired:

Type of policy: *
Home Value:
(Homeowners only)
Valuation
Personal Property Value:
(Condo/Renters only)
Valuation
Liability Limit: *
Medical Payments: *
Deductible: *
Optional Property Coverage:
Earthquake Coverage?
Flood Coverage?
Sewer/Water Backup Coverage?
Yes No
Yes No
Yes No
Current coverage:

Company

Expiration
Homeowner's Date of Birth: *

Property Information:

Construction type: *
Year Built:
Living Area Square Footage:
Number of Bathrooms:
Garage: None Carport Attached Built-in
Number of Vehicles
Distance to a fire station (miles):
Distance to nearest fire hydrant: *
What kind of pets do you have?
Do you have a swimming pool? Yes No
Do you have a trampoline? Yes No
Do you have a Wood Stove? Yes No
Do you have Smoke Detector(s) installed? Yes No
Do you have a Home Security System installed? Yes No
Is any business conducted on the premise? Yes No

Home Updates:

Enter year updates were made. If not known, enter "unknown."
Roof:
Wiring:
Plumbing:
Heating:

Property Floaters - Indicate limits below:

Antiques:
Coins:
Computers:
Fine Arts:
Furs:
Jewelry:
Firearms:
Tools:
Other Floater Coverage:

Property Type

Insurance Limit

Previous Loss Information:

Please describe any losses or claims filed on you Homeowners Insurance in the last 5 years. Include the date, value and description of each loss.

Additional Comments:

Please use the box below to enter any additional information you with to include:
How did you hear about us?
 Phone Book
 Website
 Other

 

 

 
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