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Homeowners Insurance

DEL DIOS INSURANCE SERVICES

This is not an instant quote website; our prices are too low to list online. Please fill out the quote form to obtain a Homeowners insurance quote, and an insurance specialist will contact you shortly. Please understand this is not an application for insurance. An application will be sent to you if coverage is desired.

* Required Information

Homeowners Fact Finding Questions

Of the following, what is the primary reason you insure your home?	Liability Protection
	Loan Required
	Replace Investment

In the order of importance, what is most important to you?	Price
	Service
	Proper Coverage

Approximately, when was the last time you did a review with your agent?	Within the year
	Over 2 years ago
	Over 5 years ago
	Never

How much out of pocket expense could you afford if your home were destroyed?	$

Would you be interested in going to higher deductibles to reduce your premium?	Yes
	No

In the event of a lawsuit, accident, or judgment would you want to:	Maximize Protection
	Assume Some Risk

In the event of an untimely death, is it important to you that your surviving spouse and/or children maintain the quality of life you currently have together without debt?	Yes No

Personal Information

First Name

Your Last Name

Gender

Male Female

Date of Birth

Marital Status

Occupation

Education: Possible 5% Discount

Home Address

Zip Code

The Best Time to Call?

Cell Phone

* Email Address

Home Phone

Work Phone

Fax

Your Home Information

Home Types

Residence Types

Dwelling Replacement Cost:

Year Built:

Construction Type

Roof Type

Number of Stories

SquareFeet of House

Number of Bedrooms

Number of Bathrooms

Fireplace

Garage Types

Central Air Conditioning:

Yes No

Has the brush been cleared by 250 feet from all sides of the building?

Yes No

Electrical System

Utilities Type

Home Options:

Pool	Fenced Pool
Yes No	Yes No

Security Options:

Smoke Detectors	Dead Bolt Locks
Yes No	Yes No

Fire Extinguisher	Automatic Fire Sprinklers
Yes No	Yes No

Home Owners Association?

Yes No

Your Policy Information

When Do You Need This Policy to Start?

How long have you lived at your present address

Current Insurance Company?

Current Annual Insurance Premium?

Is your policy being Canceled or Non-Renewed? (We can help!)	Yes No

If you are being canceled or have any reported claims in the last Five years, briefly explain why: (reason/date/description/amount paid/claim opened or closed)?

Desired Deductible?

Liability Amount?

Medical Payments

Do you need Earthquake Protection?	Yes No

Do you need Mortgage Protection Insurance?	Yes No

To receive a larger discount would you consider also insuring your cars?	Yes No
Do you need a Home Warranty Quote?	Yes No
Do you need a Flood Insurance Quote?	Yes No

Do You Need an Umbrella Policy?

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