Request a Homeowner's Insurance Quote

For immediate quotes, call Dave Erickson at 805-639-3304.  If you prefer to request a quote on-line, please fill out the form below.  Quotes are returned the same business day, in most cases.

 

 

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Request for Homeowner's Insurance Quote

Contact Information:

First Name
M.I.
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
E-mail Address
Phone
Bold = Required field
Property Info:
Garage
Located on a hill or slope? 
Alarm Type
Additional
Property Owned?
Roof?
Electrical?
Plumbing?
Brush?  How far away from house?
Updated Wiring?
Construction Type
If yes, Describe
Occupation of Prospects
Property Address
Sq. Ft.
# of Stories
Yr Built
Garage
Attached
Detached
Roof const.
Tile
Comp. Shingle
Shake
Electrical is:
Circuit Breakers
Fuses (unacceptable)
Swiming Pool
or Spa?
Yes
No
Alarm or
Security System?
Yes
No
Yes
No
Fire Extinguisher?
Smoke Detector?
Yes
No
Deadbolts?
Yes
No
Any Losses in the
last three (3) years?
Yes
No
If yes, describe:
Types of animals, if any:
Is there any business conducted from the premises?
Yes
No
If yes, describe:
If dweling is over 30 years old, what is the date of:
Yellowpages.com



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