Home Insurance Quote

(Washington & Oregon residents only)

Your home is probably your most valuable asset.  For this reason, you should have a homeowner policy that gives you the protection you need. The amount of insurance for your home is determined by using square footage figures along with factors such as construction quality and whether your home has central air, a fireplace, etc.  This information helps to accurately determine the replacement cost of your home.  This figure is independent of your home's market value.  Please fill out the preliminary form below.  There are no required fields, and the information is confidential.

If you prefer not to complete this form, please send us an email at quotes@blaineinsurance.com, or you may obtain a quote by faxing your current home declaration pages to 360-738-0193.  As well, you can talk to us in person by calling 360-647-0090 or toll free at 800-676-0090.

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Name of Owner
Present Address
Property Address
City
State Zip
Work
Phone
Home
Phone
E-mail (enter correctly or leave blank)
Present Home Insurance Co.
Home Now Insured For?
Current Value of Home?
How long at present address?
How long at present job?
Occupation
Number of claims in last 3 years?  Do you have flood or earthquake coverage?
Flood Earthquake
Square footage of home excluding garage and basement?
Year home was built? Year Remodeled?
 TYPE CONSTRUCTION FOUNDATION ROOF
1-Story
1 1/2-Story
2-Story
Split Level
Bi-Level		 Frame or Stucco
Masonry Veneer
Masonry		 Basement
Crawl Space
Slab		 Asphalt Shingle
Wood Shingle
Tile or Slate
Other
Age of Roof
GARAGE BATHROOMS OTHER FEATURES
1-Car
2-Car
3-Car
4-Car		 Attached
Detached
Basement
Built-in
Car Port		 # of Full

# of Half

 Central Air Cond.  
 Central Vacuum  
 Security System  
 Sauna  
 Whirlpool Tub  
 Other  
FIREPLACES BASEMENT DECK, PORCH, PATIO
# of Chimneys  
# of Hearths  
Square Feet
Finished Yes No
Deck sq. ft.
Porch sq. ft.
Screened
Patio sq. ft.
Please include any comments, i.e., previous losses, personal belongings to itemize, special features, etc.

This is only a quote and does not bind coverage in any way.

Auto Insurance Quote | Life Insurance Query | Other Insurance Quotes

Thank you for your interest!  Email us at mailto:mary@blaineinsurance.comor call 360-647-0090 or toll free at 800-676-0090 for further assistance or questions.


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