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Home Owner's Insurance

Quote Request Form





 

 

 

 

 

   Fields with red asterisks are required. The more information you provide to us, the better and more accurate the quote we can provide.

Your contact information
First Name *
Last Name *
Date of Birth
Email address *
Phone *
Cell Phone
Best time of day to reach you?
   

   

Information on the Residence to Insure
Street Address
Street Address
City
State
Zip / Postal Code
   
Year the building was constructed

  

Approximate living space size in square feet (excluding basement and any garage on the property)

  

SF 
Value in current real estate market

  

$ (approximate)
What type of construction?

  

Number of Stories

  

Exterior finish on building

  

What is the interior ceiling height in most rooms?

  

What is the type of flooring in most rooms?

  

What is the type of interior wall in most rooms?

  

Type of basement?

  

Is the basement suitable as a living space?

  

Number of bathrooms

  

Number of bedrooms

  

Number of rooms with fireplaces

  

Number of wood burning stoves

  

Does the home have central air conditioning?

  

Type of heat in the home

  

Type of roof on the home

  

Type of kitchen counter tops

  

    

   

Additional Information on the Residence
Is there a garage attached to the home?

  

Size of attached garage

  

Is there a detached garage or shed on the property but not part of the house?

  

Is there a dog at the home?

  

If there is a dog, what is the breed?

  

Is there a swimming pool?

  

Is there a trampoline?

  

Is any kind of business conducted at this home?

  

Type of building?

  

Is business equipment stored or used at this home? (Such as tow truck, or parking for commercial vehicles)

  

Is a boat stored at this home?

  

Is there an indoor fire sprinkler in the building?

  

Is there a smoke detector in the building?

  

Type of fire alarm in the building?

  

Distance to the nearest fire department station?

  

Distance to the nearest fire hydrant?

  

Type of burglar alarm in the building?

  

   

Your Insurance Information
Do you currently have insurance on this property?

  

Do you have any other insurance with Oasis?

  

Has your insurance (home, renter, auto, etc.) been canceled for any reason in the past 3 years?

  

How many home insurance claims have you had in the past 3 years?

  

How do you use this home?

  

Replacement should be based upon what value?

  

Do you want to insure for liability for any of the following: injuries, death, medical expenses related to injuries, etc.

  

Do you want to insure for water/sewer overflow?

  

Do you want to insure furniture and items in the home: jewelry, computers, etc.?

  

What deductible do you wish for the insurance?

  

Do you wish to include personal liability with the insurance?

  

    

Additional Information
Use the text box below to add information that you would like to include.

 
How did you hear about Oasis Insurance? 
 
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