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Your Local Insurance Company – Get a Personalized Quote
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My name is Katie, and I am excited to assist you. What type of insurance are you intested in today?
Home Insurance
Auto Insurance
Business Insurance
Other Insurance
Katie is asking…
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Home Insurance Request Form
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Personal Information
Primary Contact Information
First Name
Last Name
Email
Phone Number
Birthday
*
Do you have a spouse or is there a second name insured?
*
No
Yes
Spouse or Second Named Insured
First Name
*
Last Name
*
Birthday
*
Property Address
Street Address
*
Street Address
City
*
State
*
ZIP Code
Next
Property Information
Property History
Date Purchased or Escrow Close DAte
*
Have you lived here longer than Three years?
*
No
Yes
Prior Address Details
Street Address
*
Street Address
City
*
State
*
ZIP Code
Property Information
Type of Build
*
Luxury
Custom
Semi-Custom
Builder's Grade
Occupancy Type
*
Primary
Landlord
Seasonal
Renter
What year was your home built?
Square Footage
*
Number of stories
*
Please Select
1 Story
2 Story
3 Story
4 Story
The foundation of this property is:
*
Basement
Crawlspace
Slab
Piers
The Siding Material of this Property Is
*
Vinyl and Composite Siding
Wood Siding
Fiber Cement Siding
Masonry Veneer
Stucco
Metal Siding
Concrete and Specialty Siding
Is the home on Propane?
*
No
Yes
Type of Garage?
*
Attached Garage
Detached Garage
Number of Car Spaces
Please Select
1 Car
2 Cars
3 Cars
4 Cars
5 Cars or More
Back
Next
Roof & Energy Features
Roof Information
The Roof is
*
Asphalt Shingles
Metal Roofing
Clay or Concrete Tiles
Wood Shingles/Shakes
Slate Roofing
Synthetic/Composite Shingles
The Age of the roof
- Years
Solar Panel Information
Does the property have solar panels
*
No
Yes
Number of Solar Panels
The solar panels are
*
Roof Mounted
Ground Mounted
Back
Next
Fireplace & Heating
Fire Place Information
Does the property have Fireplaces
*
No
Yes
Number of Fireplaces
Wood Stove Information
Does the property have Wood Stoves
*
No
Yes
Number of Wood Stoves
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Next
Safety & Security Features
Select any Safety Devices Your Home Has
Burglar Alarm
Burglar Alarm That Sounds
Fire Alarm
Fire Alarm that Reports to a Fire Station or Security Company
Fire Sprinklers
Multiple Fire Sprinklers Throughout the Home
Backup Generator
A Backup Generator
Home Automation System
Home Automation System
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Next
Exterior Features
Attached Deck Details
Do you have any attached Decks ?
*
No
Yes
Square Footage of attached Decks
The material the deck is made of
*
Pressure-Treated Wood
Cedar
Composite Decking
PVC Decking
Hardwood (e.g., Ipe)
Concrete
Pool Details
Do you have a pool?
*
No
Yes
Does your pool have a Diving Board
*
No
Yes
Does your pool have a Slide
*
No
Yes
Is your pool or yard fenced
*
No
Yes
Pet Information
Do You Have Dogs?
*
No
Yes
List of All Dog Breeds
Dog Breed
*
×
Add new
Back
Next
Additional Information
Recent Claims
Have you made any claims in the past SIX years?
*
No
Yes
Please provide details of all claims filed in the last 6 years (date, amount, description of loss)
Additional Property Structures
Are there other structures on the property
*
No
Yes
Please provide details of all separate structures (size, material, foundation, roof and use)
Submit
Back
Katie is asking…
Start Over
Auto Insurance Request Form
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Last Page
Personal Information
Primary Contact Information
First Name
Last Name
Emaiil
Phone Number
Address
Street Address
*
Suite, Apt. etc.
City
*
State
*
ZIP Code
Next
Driver(s) Information
Driver List
List All Drivers
First Name
Last Name
Drivers License Number
*
Birthday
*
Occupation (For Discount)
Is the driver a student with a B average or better?
*
No
Yes
×
Add Driver
Back
Next
History
Previous Claims & Tickets
List All Claims & Tickets in the last 5 years
Claim or Ticket?
*
Claim
Ticket
Who was at Fault?
*
Myself
Someone Else
Date of Incedent
*
Ammount
×
Add New
Back
Next
Vehicle Information
List of Vehicles
List of all Vehicles Under Policy
Vehicle ID
*
Vehicle Usage
*
Commute
Pleasure
Annual Mileage
Vehicle Odometer
×
Add Vehicle
Submit
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Katie is asking…
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Business Insurance Request Form
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Commercial insurance is one of our many specialties. Let's first start by setting up your general business info.
Legal structure of business
*
Please Select
Legal Structure
Individual
Partnership
Corporation
Joint Venture
Sub Charter S
Not for Profit
LLC
Other
Business Name
*
Year your business was started
Do you have a DBA ("Doing Business As")
*
No
Yes
Type of Business
*
Please Select
Agriculture
Mining
Construction
Corporation
Transportation
Wholesale
Retail
Finance
Services
Public Administration
Other
Business annual revenue
*
Number of Emplyees
*
Please Select
Less than 50 People
50 to 100 People
100 or More People
Next
We're proud to work with a lot of established businesses just like you. Could you please describe your location?
Company Website URL
This is a home-based business
*
No
Yes
I have multiple locations
*
No
Yes
I Own This Location
*
No
Yes
Back
Next
Thanks ! Let me collect some general coverage information.
Coverage Start Date
*
Are there current claims with this business?
*
No
Yes
Are you currently Iinsured?
*
No
Yes
Are You in Need of Liability Coverage
*
No
Yes
Are you Insuring a Property
*
No
Yes
Back
Next
I just need to collect a few more details, and you'll be on your way!
First Name
*
Last Name
*
Emaiil
*
Phone Number
*
Submit
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Katie is asking…
Start Over
Other Insurance Request Form
1
2
Last Page
Personal Information
Primary Contact Information
First Name
Last Name
Emaiil
Phone Number
Address
Street Address
*
Suite, Apt. etc.
City
*
State
*
ZIP Code
Next
Insurance Information
What type of insurance are you interested in?
Submit
Back
Call Me
Email Me
Insurance
Auto and Homeowners Insurance
Auto Insurance
Liability Coverage
Comprehensive Coverage
Collision Coverage
Uninsured Motorist Coverage
Diminishing Deductible
Accident Forgiveness
Roadside Assistance
Specialty Auto Insurance
Towing
Rental Reimbursement
Mexican Auto Insurance
Medical Payments Coverage
Home Insurance
Property Insurance
Homeowners Liability
Renters Insurance
Condo Insurance
Mobile Home Insurance
Scheduled Property Insurance
Landlords Insurance
In-Home Business Insurance
Other Personal Insurance
Identity Theft
Personal Umbrella Insurance
Data Backup Services
Life Insurance
Individual Life Insurance
Group Life Insurance
Long-Term Care Insurance
Mortgage Protection Insurance
Disability Insurance
Second-To-Die Policy
Key Person (Key Men) Insurance
Recreational Vehicle Insurance
Boat Insurance
Motorcycle Insurance
Motorhome Insurance
ATV Insurance
Snowmobile Insurance
Additional Insurance Services
Special Event Insurance
Other Services
Wedding Insurance
Coverage for Specific Industries
Restaurant Insurance
Retail Insurance
Coverage for Your Business
Office Insurance
Professional Liability
Our Agency
Suburban Family Cares
About Us
Our Location
Our Brokers
Our Carriers
Resources
Testimonials
Fire Prevention & Safety
Contact Us
Get a Quote
Contact Information:
service@edhinsurance.com
916.804.7848
895 Embarcadero Drive, Ste 206 El Dorado Hills, CA 95762
