Home Owners Insurance - McClure and Associates Insurance Specialists, Inc.

Homeowners Insurance Quote

We would like to provide you with a free, no-obligation homeowners insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Personal Information:
Name:
Address:
City:
State:	Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Other Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Day Phone:
Night Phone:
Best Time To Call:	AM PM
Email Address:
Occupation:
How long at current employer:

Current Insurance Information
Company Name
Expiration Date:
Premium Amount:
Amount Insured For:
Policy Type:	Primary Secondary
Term:	6 Months 1 Year Other



Home Information
How Long at Present:
Year Home Built:
Number of Claims in Past 3 Years:
Square Footage (Excluding Garage & Basement):

Structure Information
Type:	1 Story 1 1/2 Story 2 Story Split Level Bi-Level Other
Construction:	Frame Stucco Veneer Masonry Other
Roof:	Asphalt Shingle Wood Shingle Tile or Slate Other
Age of Roof:
Foundation:	Basement Crawl Space Slab Other
Garage:	None 1 Car 2 Car 3 Car 4 Car None Attached Detached Basement Built-in Car Port

Features
Full Bathrooms
Half Bathrooms:
Basement:	None Finished Unfinished
Basement Square Feet:
Deck Square Feet:
Porch Square Feet:
Screened Patio Square Feet:
Number of Chimneys
Number of Hearths:

Additional Features
Heating System:	None Electric Gas Oil Propane Solar Other
Woodburning Stove:	Yes No
Central Air:	Yes No
Central Vac:	Yes No
Security Alarm:	None Monitored Un-Monitored
Fire Alarm:	None Monitored Un-Monitored
Smoke Detector:	Yes No

Additional Comments:

McClure & Associates Insurance Specialists, Inc.
420 N. Chestnut Avenue Oconto Falls, WI 54154
Tel 920.848.4000 Fax 920.848.4001