Entry 152 – Brian Nowak

Your Service is just amazing. No matter what we need or when we need it, you are there!

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Hello! What would you like a quote for?(Required)

Auto

Home / Condo / Renters

Business Owners Package

Umbrella

Rental Property

Motorcycle

Boat

Life or Health

Check all that apply. You can tell us if there is something else you need a quote for in just a moment.

Your Name(Required)

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Phone number

Best day-time phone number

Email(Required)

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Who is your insurance with now?

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What led you to request this quote?(Required)

Dave Ramsey Referral

Internet Search

Facebook Search/Page

A friend/family referred me

If family/friend - what is their name?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Let us know your current living situation

Your Date of Birth

Your highest level of education

Your occupation

Spouse Name

First Last

Spouse Date of Birth

Spouse's highest level of education

Spouse's occupation

Homeowner - Preliminary Underwriting Questions(Required)

Check all boxes that apply

A fire hydrant within 1000 feet and fire station within 3 miles

Roof is under 15 years old

Roof is between 16-22 years old

Roof is over 23 years old

Roof will be replaced in next 2 years

Home has a sump pump with a backup system

Home has a sump pump with NO backup system

The home does not have a free standing wood stove

The home has a free standing wood stove

Yes, there is an above ground pool

Yes, there is an in-ground pool with no diving board

The pool is fenced or has a railing around the perimeter

Yes, there is a hot-tub with a cover

Yes, there is a trampoline with a net

Yes, there is a trampoline without a net

Yes, we have a dog

Our dog is one of these: Akita, American Stafford Terrier, Bullmastiff, Chow Chow, Doberman Pincher, German Shepherd, Pitt Bull, Presa Canario, Rottweiler, Wolf Hybrid, Mix of any of these kinds.

The home is used as an AirBnB

We own a drone

We own hobby aircraft

We rent land for farming or parked travel trailer

Describe any detached structure. Give size, construction and use

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