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763.295.4900
 

HOMEOWNERS POLICY QUOTE

Basic Information

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

The information below is optional, but will help speed up the quote process.

Home Information

Type of Home:
Rambler
Two Story
Four Level
Bi-Level
Basement:
Finished   %
Un-finished
Slab
Construction:
Frame
Other:
Other Structures:
Other Structures Size(s):
Year Built:
Square Footage:
Year Roofed:
Roof Type:
# of Families:
Size of Lot:

 
Type of Heat:
Natural Gas
Propane
Electric
Heading and Plumbing Current?
Yes   No
Garage:
One Car
Two Car
Three Car
None
Garage Type:
Attached
Detached
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 © 2022

 
Phone: 763.295.4900
763.295.6976


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