Home Insurance Quote
 

“ In order to get a prompt, accurate quote and to lock in the discounts you are entitled to, please answer the questions below. We keep all information you give us private and confidential.  We will contact you within 24 hours!"
 

     
First Name
 MI
 Last Name
Street Address
 Apt. #
  
City
 State
 Zip
Phone#
 Best time to contact
 Fax #
E-mail Address
    
Date of Birth
, 		Marital Status
     
Current Coverage's    
Present Insurance Co.
 Current Annual Premium
Present Dwelling Coverage
 Present Personal Liability Amount
Renewal Date
 Occupation
Claims in last 3 years
0  1  2  3  4+ 		Ground floor square footage
Year the home was built
  
   
Type Construction
1- Story  Frame or Stucco
1 1/2 - Story  Masonry Veneer
2 - Story  Masonry
Split Level  
Bi - Level  
   
Foundation Roof
Basement - Finished Yes  No  Asphalt Shingle
             Square Feet  Wood Shingle
Crawl Space  Tile or Slate
Slab  Other
    Age of Roof
   
Garage Exterior Wall Covering
1-Car     Attached Wood Siding
2-Car     Detached Brick
3-Car     Basement Vinyl Siding
4-Car     Built-In Other
                   Car Port  
   
Fireplace or Woodstove
   Yes     No		  
   
     

"Thank you for filling out this form for a quote.
We will contact you within 24 hours!"

     

 
     

Black & Associates Insurance Inc
8605 N. Division  Spokane, WA
Citywide Call: 1-509-464-0058
Out of Area Call: 1-800-576-0075
info@jbbinsurance.com

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