california auto insurance

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california auto insurance
On-Line Jewelry
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

Your Name:
Property Address:
State: MUST be Florida!
E-Mail (again for accuracy):
Fax (optional):
Underwriting Information
Describe Jewelry/Fine Arts/Collectibles:
(List 1 item per line and dollar
value next to each)
Where are Jewelry/Collectibles kept?:
Number of residents in household?:
Number of miles from nearest fire station?:
Central Station Alarm? Yes No
Deadbolt locks on all exterior doors? Yes No
Wallsafe on Premises? Yes No
Are any items kept away from premises, loaned or on exhibit, or worn by someone else?
(If yes, explain below in remarks)
Yes No
Co you have current appraisals on these items?
(Please tell when last appraisals were done in appraisal comments)
Yes No
Appraisal Comments:
Currently Insured? Yes No
Name of Carrier & how long insured?
Prior Claims? Yes No
Describe claims in detail:

Jewelry $
Jewelry $
Fine Arts $ Other Collectibles $
In-Vault $
Off-Premises $
Deductible Desired:
($250, $500, $1,000, etc.)
Send my quotation via: E-Mail Fax
Regular Mail

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 Basic West Insurance Agency to release this information via the method you have chosen, and to release them 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 Quote NOW!

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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# OB18167
E-Mail us at: ALIVE