Homeowner, Renter, or Mobile Home Application With this information we can get started on your quote more quickly. There are four parts: 1. Contact Information2. Resident Information3. Dwelling Information4. Background Information Step 1 of 4 25% 1. Contact Information:Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Work PhoneCell PhoneEmail* Preferred Contact MethodHome PhoneWork PhoneCell PhoneE-mail 2. Resident InformationInsuredName First Last DOBSS#Employer and OccupationYears EmployedMarital StatusMarriedSIngleSeparatedDivorcedWidowedEducation LevelHigh SchoolAssociate's DegreeBachelor's DegreeSpouseName First Last DOBSS#Employer and OccupationYears EmployedMarital StatusMarriedSIngleSeparatedDivorcedWidowedEducation LevelHigh SchoolAssociate's DegreeBachelor's DegreeChildren in Household:NameDOBSS# (if any) We need this information for each child. Click the + button to add another child. 3. Home InformationType of InsuranceHomeownersTenant DwellingRentersMobile HomeYear Built - if knownNumber of StoriesGround Floor Sq. Footage - if known2nd Floor Sq. FootageNo. of RoomsNo. of BathsNo. of FireplacesCentral AirYesNoCentral HeatYesNoSpace HeaterYesNoConstruction Type - if knownStucco, Wood, Brick, Brick Veneer, Etc.Roof TypeMetal, Compensation, Etc.Age of Roof (in years)YearMakeModelLength (in feet)Width (in feet)Serial NumberType of ResidencePrimary ResidenceSeasonal ResidenceTenantVacantFireplace?YesNoFactory Installed Fireplace?YesNoExteriorWood / MasoniteVinyl SidingMetal 4. General InformationLocation to be InsuredAcresIn Mobile Home Park?YesNoInside City Limits?YesNoYears Lived ThereGarage Size (no. of cars)AttachedDetachedCarportNoneAttachedDetachedPorch Size (sq. ft.)AttachedDetachedOther Buildings:TypeSq. Footage Greenhouse, Shed, Workshop, etc. Click the "+" button to add another building.Updates in House Plumbing Heating Wiring Year Plumbing UpdatedYear Heating UpdatedYear Wiring UpdatedAnimals:Type (Dog, Horse, etc)Breed (of Dog) Click the "+" button to add another animal.Pool?YesNoTrampoline?YesNoAmount of Insurance NeededAmount for BuildingAmount for ContentsAny Special Insured ItemsAny Claims in the Last 5 years?YesNoPlease Describe the ClaimAmount PaidMortgageePrior InsuranceInsurerExpiration Date Years with InsurerTo provide you a firm estimate, our Insurance carriers use information from various reports, such as House Hold Summary Report, C.L.U.E. (claims history) and credit, from consumer reporting agencies. These reports periodically could be ordered to renew or update your insurance. You can obtain a copy of your reports for verification or correction within 60 days through the consumer reporting agencies. Talley-Reed Insurance Agency has strong procedures in place to protect your personal information.