California insurance from Wise Insurance Agency
FAST & FREE Online Califonia Business and Personal Insurance Quotes!
Personal Auto, Homeowners Insurance from Wise Insurance Agency
Personal Auto, Homeowners Insurance from Wise Insurance Agency
 • Auto Insurance

 • Homeowners \Renters

 • Personal Umbrella

 • Recreational Vehicle

Commercial and Business Insurance from Wise Insurance Agency
 • Contractor Liability

 • Business Owners

 • Innkeepers Insurance

 • Workers Compensation

 • Builder's Risks

 • Commercial Auto

 • Special Event


Other Insurance Services from Wise Insurance Agency
 • About Our Agency

 • Questions? E-Mail Us!

 • Policy Changes

 • Insurance Certificates

 • Office Map/Directions

 • Free Reports!

California Insurance Lic #0770590

Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data:
 
Your Name:
Property Address:
City:
Your "County" is?
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:
 
Is this Builder's Risk?
(new home constr.) 		NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
 
Type foundation: Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
 
Type Construction: Frame
Brick/Veneer
Stone
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:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant: 		# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Rate Your Credit History and Past Insurance Payment History:
(Some companies products are
based on your credit and payment history.) 		Excellent Fair
Poor Horrible
 
Primary Policyholder's Birthdate:
(Some companies products
offer discounts for certain age groups.)
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
 
Heating Type: Gas (Propane or natural)
Electric
Oil (if oil, list tank location in remarks)
 
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, oil tank location, or other special coverages/remarks 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 Quote NOW!

Click Button Below When Done

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

Wise Insurance Agency . 3100 Kerner Blvd. Suite H . San Rafael, CA 94901 . Lic#0770590
Toll Free Phone: 800-939-8730 . Phone: 415-258-9912 . Fax: 415-457-6428
Our Normal Office Hours are: 9:00 to 5:00, Weekdays | View Our Privacy Notice
E-Mail us at: contactus@wiseinsuranceagency.net | Website Design © 2006, Insurance Web Sales