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763.295.4900
 

HOMEROWNERS POLICY QUOTE

Basic Information

Applicant Information
Name:  First:   Middle Initial:   Last:  
Date of Birth:   
Co-Applicant Information
Name:  First:   Middle Initial:   Last:  
Date of Birth:   
Address:   
   
City:    State: MN  Zip:
Phone Number:    Email:  
Website:   

Home Information


Type of Home: 
Rambler
Two Story
Four Level
Bi-Level
Year Built:  Square Footage: 
Year Roofed:  Roof Type: 
# of Families:  Size of Lot:

Basement: 
Finished   %
Un-finished
Slab

Construction: 
Frame
Other:

Garage: 
One Car
Two Car
Three Car
None

Type:
Attached
Detached

Other Structures: 
Size:

Type of Heat: 
Natural Gas
Propane
Electric

Heating & Plumbing
Current? 
Yes 
No
Check all that apply:
Smoke Detector  Deadbolt  Extinguisher  Wood Burner  Trampoline  Vicious Dog

Current Insurance Information


Dwelling Coverage Amount: 
$    

Deductable: 
$100
$250
$500
$1,000

Liability: 
$100,000
$300,000
$500,000
$1,000,000

Current Mortgage Information

Company:   
Address:   
City:    State: Zip:
 

Coverage Amount: 
$    

Deductable: 
$100
$250
$500
$1,000

Liability: 
$100,000
$300,000
$500,000
$1,000,000

Monticello Agency
3616 School Blvd. Suite 100
Monticello, MN 55362

Monticello Agency © 2018

 
Phone: 763.295.4900
763.295.6976


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