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Homeowners/Condo Quote Request

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Applicant Information ¬




Contact Information ¬

How should we contact you during business hours?
(if via phone, you must enter the phone number(s) above)



Home/Condo Information ¬

Street address of home/condo to insure:
How long at this address?
If you have lived at the home/condo you want to insure for less than 3 years, what was your prior address?



Current Insurance Information ¬

Do you currently have homeowners/condo/renters insurance? Yes   No
If so, Expiration Date?
If so, name of current auto insurance company:



Policy Details ¬

For how much do you want to insure your residence?
Desired Deductible:
When do you want this policy to begin?



Dwelling Information ¬

Usage:
Type of Residence:
Type of Construction:
# Miles from Nearest Fire Department: Type of Wiring:
Within 1,000 Feet of Fire Hydrant: Yes   No Type of Heat:
If Townhouse, # of Units:   Not Applicable Type of Roof: Pitched   Flat

Upgrades (if applicable) ¬

Wiring:Yes   NoIf Yes, when:
Heating/AC:Yes   NoIf Yes, when:
Plumbing:Yes   NoIf Yes, when:
Roof:Yes   NoIf Yes, when:
Alarm System:Yes   No
Deadbolt Locks:Yes   No
Smoke Alarms:Yes   No
Sprinklers:Yes   No
Fire Extinguisher:Yes   No
Any Supplemental Heating: (fireplace, wood stove, etc.)Yes   No
Swimming Pool:Yes   No
Any Claims During Past 5 Years:Yes   No



Coverage Information ¬

If you have your policy readily available, please complete the following information. Otherwise, leave blank.

[Note: The standard homeowners/condo policy provides certain amounts of coverage for valuable items (such as jewelry, furs, fine arts, silverware, musical instruments, guns, coins, stamps and collectibles). Please let Triumph know if you want coverage for any of these items beyond the amount of automatic coverage provided.]




Comments ¬

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