Alabama Vacant Home

Online Quote Request

1. Applicant(required)
2. Birthdate
3. Email(valid email required)
4. Phone Number
5. Has Applicant Filed Bankruptcy in the past 5 years?
6. Yes No
7. Any Claims in the last three years?
8. Yes No
9. General Comments & List Claims

Mailing Address

1. Street
2. City
3. State
4. Zip Code

Info on Home to be Insured

1. Desired Effective Date
2. Address
3. City
4. State
5. County
6. Zip Code
7. Occupancy Type Vacant Home Rental Seasonal Primary Residence
8. Reason for Vacancy? Pending Sale New Purchase Between Tenancy Under Renovation Job Transfer Part of an Estate Other
9. Date the home became vacant
10. Purchase Date
11. Year Built
12. Approximate Square Footage
13. Inside or Outside City Limits
14. In City Limits Outside City Limits
15. Number of Family Structure 1 2 3 4
16. Construction Type Frame Stucco or Asbestos Brick Veneer Brick / Masonry Log
17. Roof Type Shingles-Fiberglass Wood Shingles Aluminum Fiber Cement/Concrete Slate Steel Tin Roll Roofing Tar and Gravel Tile Other
18. Type of Electrical Breaker Box Fuse Box Both Fuse & Breaker Knob and Tube Other
19. Is there a Swimming Pool at the home?
20. Yes No
21. Is the home in a Corporation or LLC Name?
22. Yes No
23. Is the Primary heat source Thermostatically controlled?
24. Yes No
25. Home have Smoke Detectors?
26. Yes No
27. Is there a Supplemental Heating source?
28. Yes No
29. Any kerosene or portable space heaters?
30. Yes No
31. Is the dwelling an earth home, dome home, open pier, stilt home?
32. Yes No
33. Is the home a row home, townhouse, condo?
34. Yes No
35. Is the home a manufactured home or a modified manufactured home?
36. Yes No
37. Does the home have utilities such as Natural Gas, Electric, or Water?
38. Yes No
39. Is the home located within 1,000 feet of rising water or in an area that is prone to flooding?
40. Yes No

Coverage Issues

1. Deductible $1,000.00 $500.00
2. Dwelling Coverage Desired
3. Adjacent Structure Coverage
4. Liability Coverage Desired $100,000 $300,000
5. Policy Preferred Term
6. 3 Months 6 Months
   9 Months 12 Months
7. Vandalism Coverage
8. Yes No

Validation

1. Please input text from picture into field

 

cforms contact form by delicious:days