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Peterson Insurance: Home Quote
Questions marked by * are required.
1. Hello! We wanted to let you know that your information is PRIVATE and will not be sold to third parties. We are asking for your PRIVATE information in order to obtain the best possible quote for you. Please look for the secure forms icon in your browser before completing any online forms. If you have any questions, please don't hesitate to contact us at 574-234-2464. Thank you for the opportunity to earn your business. Please indicate your preferred method of contact. Sincerely, Peterson Insurance Agency.
  • Email
  • Mail
  • Phone
2. Name *
3. Email *
4. Phone
5. Address
6. City/State/Zip
7. Date of Birth
8. Current Insurance Company
9. Claims in last 3 years
  • None
  • 1
  • 2
  • 3 or more
10. Type of policy you need
  • Homeowner
  • Renter
  • Condo Owner
  • Landlord
11. Year Home Built
12. Number of square feet
13. Home style
  • 1 story
  • 2 story
  • Tri or Split Level
  • Other- explain below
14. Garage or Carport
  • None
  • 1-car garage
  • 2-car garage
  • 3-car garage
  • Detached garage
  • Other- explain below
15. Number of FULL bathrooms
  • 1
  • 2
  • 3 or more
16. Number of 1/2 or 3/4 bathrooms
  • 1
  • 2
  • 3 or more
17. Type of roof
  • Flat
  • Asphalt Shingle
  • Tile
  • Wood Shingles
  • Other-explain below
18. Exterior Wall
  • Frame
  • Stucco
  • Brick
  • Wood Siding
  • Aluminum Siding
  • Other-explain below
19. Fireplace
  • Yes
  • No
20. Deck
  • Yes
  • No
21. Patio
  • Yes
  • No
22. Deadbolts on all doors
  • Yes
  • No
23. Smoke alarms
  • Yes
  • No
24. Fire Extinguisher
  • Yes
  • No
25. Monitored Security System
  • Yes
  • No
26. Contents Coverage Amount (if known)
27. Additional Comments
28. Please note:

Agree Disagree
 

Downloads

home.pdf
File Size: 1260 kb
File Type: pdf
Download File
home_options.pdf
File Size: 79 kb
File Type: pdf
Download File
home_sharing.pdf
File Size: 1409 kb
File Type: pdf
Download File
equipment_breakdown.pdf
File Size: 913 kb
File Type: pdf
Download File
extended_water.pdf
File Size: 304 kb
File Type: pdf
Download File
underground_service_line.pdf
File Size: 3106 kb
File Type: pdf
Download File
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phone
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​Fax-574.289.1257​
​Toll-877.237.4346
address
​2516 Mishawaka Ave
​South Bend IN  46615
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