Gordon Insurance - Request a Homeowners Insurance Quote

Homewoners Insurance Quote Request
Please answer the following questions to the best of your ability and knowledge. Your answers will help us determine the best insurance policy and coverages for your home. If you do not know the answer to any of the questons just leave it blank and we will address the issue when we contact you.

Legal Name of Homeowner:
Mailing Address:
City/State/Zip:
Is Mailing the same as Location address?	Yes No
Daytime Phone:
Evening Phone:
Email:
What year was your house built?
Does it have?
Sprinklers	Yes No
Smoke Detectors	Yes No
Central Alarm	Yes No
Dead bolts	Yes No
If the House is more than 20 years old, what maintenance work has been done?
What is square footage of the house?
What is your current dwelling limit on the policy?
Are you concerned about Jewelry, Fine Arts, Silverware and Collectibles?	Yes No
Have you had any losses or claims in the past 3 years?	Yes No
If yes, please describe the date, claim details and amount (dollars) paid
Which best describes the exterior of your house?	Siding Siding/Brick Brick
What is your deductible? ($250 is standard)	$250 $500 $1000
Explain special features on the property (ponds, pools, sheds, tree houses,etc)
Do you have any secondary homes?	Yes No
Miscellaneous comments, questions or concerns:
Gordon Insurance also offers solutions for Auto, Umbrella and Workers Compensation insurance. Do you wish to discuss them?	Yes No
Note: All carriers subscribe to the CLUE System which will uncover claims/losses paid out over the history of the dwelling. All prior claims made on your propery – whether filed before or during your ownership – will be revealed and considered in your policy quote estimate.