1BCTR Home Quote - 618 Insurance Agency

Home Quote IL

Name*
First Last
Address*
The Location of your Home

Street Address City State / Province / Region ZIP / Postal Code
Do You have a Mailing Address?
Mailing Address*
Mailing Address City State ZIP Code
How Long Have you Lived Here*
Previous Address*
Street Address City State ZIP Code
Preferred Contact*
Home Phone*
Mobile Phone*
Consent to Text Messages*
- I Consent
We will text your quote and information throughout this process.
Work Phone*
Email*

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Occupancy*
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Construction Type*
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Vacant/Unoccupied*
Construction Style*
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Usage Type*
Exterior Walls*
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Purchase Date*
Month
Day
Year
Purchsae Price*
Year Built*
Please enter a number from 1850 to 2050.
Home Updates*
Has the Home Been Updated in the Last 20 years?
What Estimated Year Were the Updates Completed*
Please enter a number from 2000 to 2020.
Square Footage*
Number of Stories*
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Number of Families*
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No. of Addl. Residences
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Roof Composition*
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Roof Grade
Roof Shape*
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Hail Resistant Roof*
Roofing Updates*
Roofing Update Year*
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Primary Heating
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Secondary Heating*
Heating Update Year*
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Electric Update*
Electric Update Year*
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Plumbing Update*
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Plumbing Update Year*
Foundation*
No. of Baths - Full*
Please enter a number from 1 to 5.
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No. of Baths - 3/4*
No. of Baths - Half*
Please enter a number from 1 to 5.
Swimming Pool*
Trampoline on Premise*
Animals*
Policy Cancelled in last 3 Yrs*
Bankruptcy*
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Smokers in Household*
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Occupied During Day*
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Num of Family Units (Fire Divison)*

# of Mortgages*
Do you Know who your Mortgage is with and their address?*
First Mortgagee*
Bank Name Mailing address City State / Province / Region ZIP / Postal Code
Second Mortgagee*
Bank Name Mailing address City State / Province / Region ZIP / Postal Code

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