Offering affordable life, health and business insurance since 1988.

Get A Quote Today

Home
About Us
Insurance
Coverage
Contact us
Get a Quote
- Home Insurance Questionnaire
- Auto Insurance Questionnaire

Home Insurance Questionnaire

Home Insurance Questionnaire

Insurance Services in O'Fallon, Illinois

Fill Out The Form Below

Contact Us

Date

Name

Phone

Who is on the Deed

Email

Property address

In or outside city limits-

If outside, who is responding fire dept. & how far out of town

Are they within 1,000 feet of fire hydrant

How many acres or 1 lot

What County

Year Built

Square Footage

Check which it has

Fire Ext

Smoke Detectors

Deadbolts, Central Alarm

Central Alarm

How may Stories

Bi-Level

Tri-Level

Basement (finished or unfinished, walkout) or crawlspace or slab

If finished basement, need %

Frame or brick construction

If both, what is the % of each

Siding:

Vinyl

Aluminum

Wood

Asbestos

Type of Roof

For homes over 25 years old we need dates of renovation of wiring, roof, heating, & plumbing

Number of Bay windows?

Number of Picture windows?

Number of Bow windows?

Number of Skylights?

Number of Sliding Glass Doors?

Number of French Doors?

Number of Solar panels?

What are the walls & ceilings made of: (Drywall, Plaster, Etc)

What percentage of the walls are painted?

What percentage of the walls have wallpaper?

What percentage of the walls have paneling?

What percentage of the walls have ceramic tile?

Air Conditioning (central, window unit, etc)

How is the home heated?

What percentage of the floor is wall to wall carpet?

What percentage is Carpet over Hardwood?

What percentage of the floor is hardwood?

What percentage is Parquet/Laminate?

What percentage of the floor is ceramic tile?

Does any Resident of the home smoke?

Garage (attached or detached) (1 or 2 car)

Any other outside structures? (Fence, Pool (Above/Below), Shed, Barns, etc and values)

Any swimming pools? Is it fenced and locking gate?

Diving board or slide?

Fireplace (wood or gas) or wood burning stove?

If wood burner, where is it located?

Any Free Standing Fireplace?

UL approved?

Porch (open or enclosed) & sq. ft.

Deck? Sq.ft

Any Trampolines?

Caged and anchored?

How many bathrooms (full, 1/2 or 3/4)

Any dogs--what breed are they and how controlled?

Is this a new purchase, what is the date of closing?

What was your prior address if within 2 years

Year purchased?

What is the purchase price?

Already insured? (Current Company, Current Coverage & Ded Amt)

List all claims or losses for the past five years? If so, what & when and for how much paid by insurance company.

Have you ever been cancelled/non-renewed?

Is this home used for home daycare?

Do you own any recreational vehicles ie. Boats, ATV, Scooters

If so where are they covered for liability?

Earthquake or mine subsidence?

Do you want water backup or sewer coverage-- (5,000) (10,000) (25,000) Battery backup?

What are the Liability Limits needed:

100,000

300,000

500,000

What are the Medical Limits needed:

1,000

2,000

5,000

10,000

What are the electrical Amps?

Free Text

SOME OF THE COMPANIES RUN CREDIT – MUST GET APPROVAL

Date of Birth: Husband

Date of Birth: Wife

Thank you for contacting us.
We will get back to you as soon as possible.

Oops, there was an error sending your message.
Please try again later.

Contact Us

Email Us

natalie@mskagency.com

tawna@mskagency.com

Our Location

500 Southview Plz #17

O'Fallon, IL 62269

Website by Smart Digital

Serving Shiloh, & Swansea, IL

Share by: