The Pratt Insurance Agency, Inc.

Request a Homeowner's Quote

Please fill out the form below giving us as much information as possible, to ensure the most accurate quote.
Once we receive your information, we will contact you as soon as possible - usually within one business day.

Gender *

Male

Female

Name Prefix

First Name *

Last Name *

Email Type

Email *

Date of Birth *

Social Security Number

Phone Type

Phone Country

Phone Number *

Phone Extension

Address Type

Address Country

Address 1 *

Address 2

Address City *

Address State

Address Zip Code *

Marital Status *

Married

Single

Do you currently have a homeowner's Policy? *

Yes

No

If Yes, What is the current amount of insurance coverage?

If yes, is it under cancellation?

Yes

No

Do you have any prior losses?

Yes

No

If yes, please explain further:

If No, is this a new purchase, or have you been without insurance?

This is a new purchase

I have been without insurance

If this is a new home purchase, what was the purchase price?

Have you had a bankruptcy or Foreclosure in the last 5 years? *

Yes

No

Property Information

Style of Home *

# of Stories *

Property Dimensions (approximate is fine) *

# of Families *

Year Built *

Construction *

Frame

Masonry

# of Fireplaces or Hearths *

Approximate Distance to nearest Fire Station *

Approximate Distance to nearest Fire Hydrant *

# of Full Baths *

# of Half Baths *

# of 3/4 Baths *

Exterior Siding *

Clapboards

Wood Shakes

Brick

Logs

Vinyl

Other

Roof Covering

Asphalt Shingles

Fiberglass Shingles

Wood Shakes

Slate

Rubber

Other

Does the Property have the below features? Choose Yes or No.

Basement *

Yes

No

Daylight Basement

Yes

No

Finished Basement

Yes

No

Attic *

Yes

No

Finished Attic

Yes

No

Garage *

Yes

No

Attached Garage *

Yes

No

Dimensions of Garage

# of Stories of Garage

Breezeway *

Yes

No

Dimensions of Breezeway

Woodstove(s) *

Yes

No

Woodstove Inspected by

Decks or Porches *

Yes

No

Dimensions of Deck or Porch

Inground Swimming Pool *

Yes

No

Above Ground Swimming Pool *

Yes

No

Fenced Yard with Secure Gate *

Yes

No

Trampoline *

Yes

No

Outside Hot Tub *

Yes

No

Is Outside Hot Tub Covered and Locked?

Yes

No

Smoke Detectors *

Yes

No

Deadbolts *

Yes

No

Alarm System *

Yes

No

Indicate the Percentage (%) of each by typing a number below

Interior Walls: % of Drywall

Interior Walls: % of Plaster

Interior Walls: % of Wood

Wall Coverings: % of Paint

Wall Coverings: % of Wallpaper

Wall Coverings: % of Tile

Wall Coverings: % of Paneling

Wall Coverings: % of Tongue & Groove

Ceilings: % of Drywall

Ceilings: % of Plaster

Ceilings: % of Tongue & Groove

Floor Coverings: % of Hardwood

Floor Coverings: % of Carpet

Floor Coverings: % of Vinyl/Tile

Indicate the Number of Windows for each below:

# of Skylights

# of French Doors

# of Sliding Glass Doors

# of Atrium Windows

# of Picture Windows

# of Bay Windows

# of Bow Windows

# of Stained Glass Windows

If your Roof has been updated, what year did that occur?

If your Electrical Wiring has been updated, what year did that occur?

# of AMPs

If your Plumbing has been updated, what year did that occur?

If your Heating System has been updated, what year did that occur?

Do you own any dogs? *

Yes

No

If Yes, what is the Age, Breed and Temperament?

Is any Business conducted at home? *

Yes

No

If Yes, please explain:

Special Features

Please list any special features:

Copyright 2008