Thank you for your interest in a Home Owner's quote.
Please complete and submit the following form, or have the information ready and call our office at (724) 423-6775, so we may prepare your quotes.


Full Name Home Phone
Address
Email Address Work Phone
Email Address Cell Phone
Current Carrier Policy #
Coverage A Dwelling Coverage E Liability
Coverage B Other Structures Coverage F Medical Pmts
Coverage C Personal Property Replacement Cost Contents
Coverage D Extra Living Expense Backup of Sewers & Drains
Deductible Wood Burning Stove
Pool
Pool Type
Trampoline
Oil Tank
Age Of Electric Srvice Type OF Service
Age Of Plumbing Plumbing Pipes
Age Of Furnace Furnace Fuel
Year Built Living Area sq ft
Style
Stories
EXTERIOR
Roof Shape
Roof Cover
Exterior Wall
Specialty Windows
# Set Decorative Shutter # Windows
# Porches # Full Bathrooms
# Full Bathrooms # Half Baths
ROOMS
Kitchen
Counter Tops
Garbage Disposal
Range Hood
Space/Saver Microwave
Free Standing Stove
Cook Top
Built-in Oven
# Full Bathrooms # Half Baths
Dining Room Size
Living Room Size
# Bedrooms 8x6 # Bedrooms 10x10
# Bedrooms 14x12 # Bedrooms 16x14
Sq Ft Entry/Foyer # Walkin Closets
Sq Ft Laundry Room Sq Ft Utility Room
Den or Office
Garage
INTERIOR
Ave. Wall Heght
Wall Material
Interior Finish
Cooling System
Heating System
Carpet %
Ceramic % VinylSheet/Tile %
Laminate % Hardwood
Slate Other
Comments / Questions