Hannum Insurance Agency, Inc.
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Personal Information
Name
*
First
Last
Current Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
We will not send advertising or promotions to your email. It will only be used for answering questions, sending forms, or other business items.
Date of Birth
*
Social Security Number
*
Marital Status
*
Single
Married
Divorced
Widowed
Spouse's Personal Information
Spouse's information is
required
if you are married.
Spouse's Name
*
First
Last
Spouse's Mailing Address (If Different)
*
Line 1
Line 2
City
State
Zip Code
Country
Spouse's Phone Number
*
Spouse's Date of Birth
*
Spouse's Social Security Number
*
Home Information
Address of Home
*
Line 1
Line 2
City
State
Zip Code
Country
Year Built
*
Number of Stories
*
Square Footage
*
Foundation Type
*
Does it have a basement?
*
Yes
No
If so, what percentage is complete?
*
Number of Baths
*
What is the year of the most recent roof update? Use your best guess.
*
Roof material
*
Asphalt Shingles
Metal
Wood shingles
Other
Is it air conditioned?
*
Yes
No
Type of Heat
*
Siding Material
*
Do you have a garage?
*
Yes
No
Required Information
If so, what is the size of the garage?
*
1-car
2-car
3-car
Other
If you meet the criteria for any of the following questions, you are
required
to answer it.
Is there any fireplaces, woodburners, or other solid fuel devices?
*
Yes
No
If yes, please specify what kind and how many of each.
*
Is there a pool?
*
Yes
No
If so, is it above-ground or in-ground?
*
Above-ground pool
In-ground pool
Is the pool fenced with a locking gate?
*
Yes
No
Any outbuildings?
*
Yes
No
If so, please provide the type and square footage.
*
Do you own a trampoline?
*
Yes
No
If so, is there a net?
*
Yes
No
Do you have any pets?
*
Yes
No
If so, please list the type and breed of each pet.
*
Is the home currently insured?
*
Yes
No
If so, provide the current company and policy expiration date.
*
Other Information
If you meet the criteria for any of the following questions, you are
required
to answer it.
What deductible would you like for wind and hail?
*
$1,000
$2,500
$5,000
$10,000
What deductible would you like for all other perils?
*
$500
$1,000
$2,500
$5,000
$10,000
Have there been any claims in the past five years?
*
Yes
No
Have you or your spouse declared bankruptcy or had a judgment or lien against you in the past 10 years?
*
Yes
No
Maybe
If yes or maybe, please explain:
*
If so, please provide information on what the claim was about.
*
New Purchases Only
Only people that have recently purchased a house are
required
to answer these questions.
Purchase Price
*
Closing Date
*
Submission
With whom, if known:
*
Is there, or will there be, a mortgage?
*
Yes
No
An agent will contact you within one business day after you click submit.
Additional Remarks
*
Anything else you would like us to know about.
Submit
Home
Quotes
Homeowners Quote
Automobile Quote
Watercraft Quote
Health Quote
Motorcycle Quote
Renters Quote
Endorsements
Property Endorsement
>
Address Change
Mortgagee Change
Scheduled Items Change
All Other Property Changes
Auto Endorsement
>
Address Change
Vehicle Change
Driver Change
Lienholder Change
>
Add Lienholder
Change Lienholder
Delete Lienholder
Coverage Change
>
Add Coverage
Delete Coverage
All Other Auto Changes
Report A Claim
Auto Glass Claim
Auto Claim
Property Claim
Request Documents
Request New ID Cards
Request A Certificate
Request A Policy Declaration
Contact Us
About Us
Our History
Our Staff
Our Companies
Other Services
Social Media
Feedback
UA-99323310-1