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Personal Homeowners Quote

Instructions: Click on the section to enter/edit your information.

Step 1. Homeowner/Contact Information

First Name:
Last Name:
Street Address:
City:
State:
Zip:
County:
Email:
Home Phone:
Work Phone:
Date of Birth:
Gender:
How Would You Describe Your Credit Rating: Current Resident Status: Length of Time at Current Residence: Years: Months: Best Time to Contact You: Best Way to Contact You: How Quickly Do You Need Your Request Processed?:
Please provide any additional comments you have:
Are you interested in a multiple-policy discount (for auto and home insurance)?: Are you currently (or have you ever been) a Varsity Customer?:
How did you hear about Varsity:

Step 2. Current Insurance Information (if applicable)

Please tell us more about your current or recent insurance policy.
Current Insurance Company:
Policy Expiration/Renew Date:
How long have you been continuously insured with this company?
How are much are you currently paying?	$ per year

Step 3. Property Location and Type

Address of Property to Be Quoted:
Apt. Unit Number:
City/Township:
County:
State:	(we insure in Florida only).
Zip Code:
Property Type:
Number of Occupants:
Do You Currently Own (or in the process of purchasing) this property?:	If yes, specify closing date:
Do you now reside, or plan on residing at this property within the next 12 months?

Step 4. Property Information

Purchase Price:

Recent Appraisal Value:

Appraisal Date:

Year House Was Built:

Approximate livable square footage of residence (excluding basement, if any):

sq. feet

Is this your Primary or Secondary Residence?:

Dwelling Design:

Exterior Wall Type (60% or more):

Number of Bedrooms:

Number of Bathrooms:

Roof Material:

Roof Shape:

Roof Age:

Garage Type:

Describe Foundation or Basement:

Screened Porch:

If yes, then specify area: sq. ft.

Concrete Swimming Pool:

If yes, to a Concrete Swimming Pool, Do you have a diving board?:

If yes, to a Concrete Swimming Pool, Do you have a slide?:

Do you have a fenced in backyard?:

Do you have a shed?

Do you have a trampoline?:

Do you have any dogs?:

If yes, list number and breeds:

Central Burglar Alarm:

Central Fire Alarm:

Fire Station:

Fire Hydrant:

Municipal Location:

Please describe the heating system in this dwelling:

Number of gas, pellet or wood fireplaces or stoves:

Is your home prone to flooding or located in a designated flood plain?:

Property Accessories

Dead Bolts	Air Conditioning	Tennis Court
Smoke Detectors	Covered Deck/Patio	Trampoline
Fire Extinguisher	Uncovered Deck/Patio
Indoor Fire Sprinkler	Swimming Pool

Updates
(Note: Homes 30 years and older will require furnishing us with the results of a four-point inspection before quoting you.)

Roof:		Year of Update:
Air Conditioning:		Year of Update:
Plumbing:		Year of Update:
Electrical:		Year of Update:

Claims Information

Claim Type		Date of Claim:
Claim Type		Date of Claim:
Claim Type		Date of Claim:

Step 5. Additional Comments (optional)

Additional Information Section
In the box below, please provide any additional information you feel may be necessary for us to provide you with the best quote possible such as additional amenities, structures, if you have anything such as jewelry that you want additional insurance for, etc.

Step 6. Submit Information