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Great! What type of property is it?

Do you live at this property?

Approximately what year was the property built?

Approximately how many square feet?

Are you replacing an existing policy?

Do you need personal property coverage?

Do you need liability coverage?

What is the deductible amount?

Do you have any potential discounts?(check any that apply)

Do you own any of these dog breeds?(check any that apply)

Do you have any past claims?(check any that apply)

Is your home located in a floodplain?

What is your full name?

What is your email address?

What is your phone number?

Single Family Home
Multi-Family Home
Condominium
Townhome
Rental
Investment
Vacation Home
Vacant Land
Mobile Hom
Manufactured Home
Other
Yes
No
2010-2018
2000-2009
1990-1999
Before 1990
Any10k+
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Yes
No
Less than $10,000
$10,000
$15,000
$20,000
$25,000
$25,000+
Less than $100,000
$100,000
$300,000
$500,000
$1,000,000
$250
$500
$1,000
$2,000
None
Deadbolts
Smoke Alarms
Fire Extinguishers
Nearby Fire Hydrant
Manned Fire Station within 5 Miles
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None
Rottweiler
Pitbull
German Shepherd
Chow
Doberman
Wolf Hybrid
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None
Weather
Theft
Vandalism
Water
Fire
Other
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Yes
No
Continue
Continue
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