Home Quote Machine – Albano Agency

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1CONTACT

2DWELLING

3HISTORY

4SPECS

5UTILITIES

6FINISH

Primary Named Insured *

First

Middle

Last

Date of Birth

Phone *

By providing your phone number, you agree to receive text messages and/or calls for information and marketing purposes. You can opt out at any time.

Email *

Martial Status *

If married, spousal information will be required.

Would you like to add a Co-Applicant? *

All deeded owners should be listed.

Co-Applicant / Spouse *

First

Middle

Last

Date of Birth

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Have you resided at this address for less than 3 years? *

Prior Residential Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a seperate mailing address? *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is your home a pending new purchase? *

What year was your home built? *

When did you purchase your home?

When is your expected closing date?

Is your home currently insured? *

Have your insurance documents with you? *

Upload your Declarations Page *

Click or drag a file to this area to upload.

Your declarations page will contain all coverages such as dwelling, liability and scheduled items. This valuable step ensures an accurate quote, matching up all your exisiting coverages so you can truly compare the price, apples-to-apples.

Who is your current insurance carrier? *

What is the expiration date? *

Must be exact, can be found on letters, insurance docs or possibly email history.

Who was your prior insurance carrier? *

Have you submitted any homeowner's insurance claim(s) in last 5 years? *

Describe each of the claim(s) made. Provide approximate date of loss & total payout amount for each. *

Do you have any Dogs on premises? *

Have the dogs had any type of bite history? *

What year was your home built? (copy) *

Living square footage? (excluding basement) *

Include square footage for all finished and heated living spaces from ground level and above. Do not include basment below grade.

Number of Bedrooms

0 Bedrooms

Number of Full Bathrooms

0 Bathrooms

With Showering Facilities

Number of Half Bathrooms

0 Bathrooms

Without Showering Facilities

Exterior Material *

Brick
Vinyl
Wood Shakes
Wood Cladding
Cement/Hardie Board
Masonary Stone
Faux Stone
Stucco
Other

If it is mixed, check all materials that apply.

Roofing Material *

Roofing Type | Other *

What year was your roof last replaced? *

Basement Type *

Full
Partial
Crawlspace
Slab - No Basement

Entry/Exit access for Basement *

Ground Level Walk-Out
Indoor Stairwell
Outdoor Stairwell
Storm Door
Floor Hatch
Other

Check all that apply!

Basement Entry/Exit access | Other *

Please list all the entry/exit points for basement.

What percent of the basement is fully finished? 0%-100%

70%

Primary Heating Source

Air Conditioning

Primary Heating Fuel Source

Primary Heating Source | Other *

Please describe the primary heating source for your home.

Oil Tank Location *

Homes with an oil tank in-ground in the soil are ineligible for homeowner's quote.

Secondary Heating Source *

Is there an In-Ground oil tank on premises? (under the soil)

How many fireplaces in total?

0 Fireplaces

Additional heating sources in your home? *

Pellet Stove
Wood Burnig Stove
Other
None

Check all that apply!

Additional Heating Source | Other *

Please describe the primary heating source for your home.

Electric | Year Updated/Renovated *

Estimate when the utility was last fully updated/renovated. Mark N/A if original or unknown.

Plumbing | Year Updated/Renovated *

Estimate when the utility was last fully updated/renovated. Mark N/A if original or unknown.

Heating System | Year Updated/Renovated *

Estimate when the utility was last fully updated/renovated. Mark N/A if original or unknown.

Do you have a Garage? *

Garage Type

Is there a Front Porch/Stoop? *

Front Porch/Stoop SQFT

Length x Width

Finishing Material *

Wood
Composite / Trex
Stone
Concrete
Other

Is there a Back/Side Deck? *

back/Side Deck SQFT

Length x Width

Finishing Material *

Wood
Composite / Trex
Stone
Concrete
Other

Do you have a Pool? *

Pool Type *

Pool Saftey Features *

Fully Fenced-In
Partially Fenced-In
Locking Gate
Removable Stairs

Check all that apply!

Do you have a Hot Tub? *

Is the Hot Tub physically attached to your home? *

Albano's Consent Disclosure

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