Jeff Roby Insurance has a privacy policy to protect your personal information. Your info is used for quoting purposes only. Your info is not retained, sold or used for any other purpose but to provide you with an Insurance quote.
Please be advised that prior to issuing a policy, we will verify loss and credit history using consumer reports to provide an accurate quote and determine your eligibility.
If you need assistance with this form email us at support@jeffrobyinsurance.com or call 1-800-437-3958.
| Do you have any claims in past 3 years on the property we are quoting now? |
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| If so, please provide the date and description of the claim: |
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| Is this a single family home? |
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| If no, pease specify how many units |
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| What year was the home built? |
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| What would you like for a deductible? |
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| Requested Liability: |
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| If you have an amount in mind to insure the property for, enter it here: |
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If you are unsure of what to insure the building for, please answer the following questions and we will help you come up with a value to insure your home.
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| Exterior Information |
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| What is your homes total square footage excluding the basement? |
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| Please describe your home type: |
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| Description details: |
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| Exterior Siding: |
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| Details: |
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| Garage(s): |
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| If applicable the garage is: |
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| Are there any decks or porches? |
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| Is there a pool? |
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| Interior Information |
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| Do you have a central alarm system? |
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| Number of bathrooms: |
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| What percentage of your basement is finished? |
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| Heat source: |
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| Fireplaces: |
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| Do you have a wood stove? |
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| Please provide percentages of your flooring for the following |
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| Hard wood floor percentage: |
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| Carpeting percentage: |
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| Tile/Marble/Slate percentage: |
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| Lineoleum percentage: |
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| Vinyl percentage: |
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| Please indicate any other features about your home that you believe may increase its replacement cost (i.e.- jacuzzis, skylights, bay windows, etc.): |
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| Please specify any items you wish to endorse on the policy and its value(i.e.- jewelry, furs, fine arts, etc.): |
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| Are you interested in a personal umbrella policy? |
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| Please choose a coverage limit: |
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