california auto insurance

Insurance Experience You Can Count On. Secure - Reliable - Affordable!
california auto insurance
 
Dwelling Fire
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
State: MUST be California!
Zip/Postal:
E-Mail (REQUIRED):
E-Mail
(again for accuracy):
Phone:
Fax (optional):
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Number of units: 1 family Duplex
Triplex Four Units
 
Occupancy: Owner Tenant
 
Type foundation: Slab Crawlspace over slab
Basement Other (list in remarks)
 
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Are You in Brush Area? Yes No
 
Currently Insured? Yes No
 
How Is Your Credit History?
(some carriers use credit to qualify)
 
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Heating type: Gas Electric
Oil Other
 
Fuel Tank Location: In-ground Basement
Garage   Other
(Describe Fuel Tank Location)
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Fire Ins. Quote NOW!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!


 
You may contact our agency at the address and phone numbers below:
 
Alive Insurance Services, Inc.
6328 Fairmount Avenue, Suite 230   El Cerrito, CA 94530
Phone: Toll Free: 1-866-343-2437 / Phone: 1-510-524-3200
Facsimile: 1-510-524-0059 / Calif. Ins. License# 0E70937
E-Mail us at: ALIVE INSURANCE@aol.com