Farinelli Insurance Agency

Since 1961

(800) 340-9991

Homeowners Insurance quote

First Name:
Last Name:
Phone Number:
Fax Number:
E-Mail Address:
Birth date
Social Security
Who Referred You to Our Site?
PROPERTY INFORMATION
Property Address:
Property City:
Property Zip Code:
Dwelling Type:
Number Of Bedrooms:
Number Of Bathrooms:
Number of Fireplaces:
Garage Description:
Year Built:
Date You Purchased Your Home:
Type of Home
Construction Type:
Does this dwelling have a permanent and solid foundation?	yes no
Is the home on pilings or piers?	yes no
Roof Type:
Flat Roof?	yes no
Roof Updated:	yes no
If Yes, Year Roof was Updated:
Does The Dwelling Have A Pool?	yes no
If Pool, Is It Fenced?	yes no
If Pool Is It Above Ground?	yes no
If Pool, Is There A Diving Board?	yes no
If Pool, Is There A Slide?	yes no
Is There A Trampoline?	yes no
Protection Distance:
Smoke Alarm:	yes no
If Smoke Alarm, Local or Central Alarms?
If Smoke Alarm, How Many Hard Wired?
If Smoke Alarm, How Many Battery Operated?
Fire Extinguisher:	yes no
Is there a fire department within 5 miles or do you have a volunteer fire department that is manned 24/7?	yes no
Is there any brush area within 400 feet of home?	yes no
Is there a barn or other farming/ranching equipment on the property?	yes no
Is the home vacant or is it located in a neighborhood with 3 or more vacant or condemned homes?	yes no
Are there any abandoned,non operational vehicles stored at this location?	yes no
Is the dwelling owned/titled in the name of a church or non profit organization or association?	yes no
Is this property located in a gated community?	yes no
Is the home located in a commercial or industrial location?	yes no
Any business conducted on the property?	yes no
Do you employ any domestic workers more than 10 hours per week at this location?	yes no
Are there more than 2 individuals on the deed?	yes no
Are there any boarders or roommates in the home?	yes no
Is there a wood stove in the home?	yes no
If wooden stove, was it professionally installed?	yes no
Deadbolts:	yes no
Year Electrical Updated:
Circuit Breakers:	yes no
Copper Wiring:	yes no
Heating - Air Conditioning, When Updated?:
Energy Source:
If Oil, Age and Location of Oil Tank?
Year Plumbing was Updated:
Copper Plumbing:	yes no
Current Insurance Company:
Expiration Date of Current Insurance Policy:
Any Dogs on the Property:	yes no
*If Yes, Number & the Breed of Each* Dog:**
Is there any pre existing damage to the home?	yes no
Losses-Claims in the last 5 years:
*If Yes, Date, Amount Paid & Description of Each* Loss-Claim**
Has there been any prior association losses?	yes no
Is the home in foreclosure?	yes no
COVERAGE INFORMATION
Dwelling Amount (Coverage A):
Filed Bankruptcy in The Past Ten Years: (If yes describe briefly in comments)	yes no
Questions or Comments to help the Agent:
Please press the Submit Button ONCE. Then wait for online confirmation of your request. Thank you for your interest.

You may also call us at (800) 340-9991