Homeowners Quote from Hannum Insurance Agency - Hannum Insurance Agency, Inc.

Hannum Insurance Agency, Inc.

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Homeowners Quote

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? *

What deductible would you like for all other perils? *

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

Our office is open weekdays from 9:00am to 5:00pm.

No appointment needed!
412 E Main Street Crawfordsville, IN 47933

Phone: 765-362-5112
Email: hannum@hannumagency.com

© COPYRIGHT 2015. ALL RIGHTS RESERVED.

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