request for homeowners insurance quote - Ark Insurance Agency_ Inc.-ag by yaofenjin

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									               REQUEST FOR HOMEOWNERS INSURANCE QUOTE

                            ARK INSURANCE AGENCY, INC.
                         1060 NE 100TH ST, SEATTLE WA 98125
                               DOREEN SARLES, AGENT
                              Doreen@ark-insurance.net
                          OFFICE 206-522-6310, 800-448-3995
                           FAX 425-977-0118, 888-809-9224



APPLICANT NAME __________________________ DOB___________ SSN______________

CO-APPLICANT   __________________________ DOB___________ SSN______________

PHONE #1____________________PHONE #2___________________FAX ______________

EMAIL ADDRESS_______________________________

APPLICANT(S) OCCUPATION & EMPLOYER____________________________________

_______________________________________________________________________

PROPERTY ADDRESS____________________________________________________

                    _____________________________________________________

OWNER OCCUPIED OR RENTAL PROPERTY?______ HOW LONG @ ADDRESS ______

MAILING ADDRESS (IF DIFFERENT)________________________________________

                                      ____________________________________

TYPE OF ROOF __________________ , AGE OF ROOF ______, AGE OF ELECTRICAL ______

AGE OF PLUMBING _______ ANY GALVANIZED PLUMBING? ____

WHAT TYPE OF HEAT?_________ AGE OF FURNACE _______

IS THERE AN ALARM SYSTEM INSTALLED?_______ BURGLAR - FIRE – OR BOTH

IS THE ALARM MONITORED? _____

WHO IS YOUR CURRENT INSURANCE COMPANY? (PLEASE ATTACH COPY OF YOUR CURRENT
POLICY DECLARATION PAGE, IF AVAILABLE) ________________________________________

POLICY NUMBER ________________________ EXPIRATION __________________

LIST ANY CLAIMS WITHIN THE PAST 5 YRS? _______________________________________

____________________________________________________________________________

____________________________________________________________________________

								
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