Anderson and Black - Washington State Insurance Company, Auto Insurance, Life Insurance, Health Insurance, Employer Insurance

Home Personal Commercial Life & Health

Home Insurance Quote

PRIVACY POLICY
Any personal information you provide here is used solely for the purpose of providing you quotes for insurance. This information will only be shared with those companies and vendors necessary to produce the quote. Anderson & Black will not sell or provide this information to any third party accept as required by law. Nothing disclosed in this quote can be made available to any employer or group of which you are a member except as you might request. This is a request for a quote only and will not result in repeated and unwanted solicitation by phone or mail. We will contact you with the results by the means you request; phone, email, fax, mail.

Please fill out the information below. All fields marked with an * are required.

Association or Employer Group?	If yes, which:
Yes No

YOUR NAME
First Name: *	MI:	Last Name: *

SPOUSE'S NAME
First Name: *	MI:	Last Name: *

CONTACT INFORMATION
Mailing Address:	City:	State:	Zip:

Physical Address: (if different)	City:	State:	Zip:

YOUR INFORMATION
Residence is: *
Owned Home Owned Condo Rented Home/Condo/Apartment
Contact Phone:	Fax:	email:

Date of Birth: *	SSN:

CURRENT HOME/CONDO/RENTERS/RENTAL INSURANCE
Current Insurance Company:	Policy Number:	Deductible:

CLAIMS FILED IN THE LAST 5 YEARS
Date:	Loss Type:	Amount:

Date:	Loss Type:	Amount:

COVERAGE INFORMATION
Current Building Coverage Limit

Alarm System	Year Roof Last Replaced
None Monitored Fire/Burglar Un-Monitored Alarm

Renters and Condo Coverage Desired
Personal Property	Condo Buliding Items

Alarm System		Year Roof Last Replaced
None Monitored Fire/Burglar Un-Monitored Alarm

DWELLING
Year Built	Square Feet	Stories	Basement?	Finished Feet in Basement
		1 2 Bi-Level	Yes No

Attached Garage:
1 Car 2 Car 3 Car 4 Car
Non-Attached Garage:
1 Car 2 Car 3 Car 4 Car
Materials:
Frame Brick/Masonry Brick Veneer Log

Any questions or comments:

We obtain as much information as possible from county assessor?s offices. Please use the "questions or comments" section to indicate any special features, concerns or insuring requirements for your home.