Home Insurance Quote Request Step 1 of 10 10% What is your full name?* What is your date of birth?* What is you social security number? Are you married?* Yes No What is your spouse's name?* What is your spouse's date of birth?* What is you social security number? Will anyone else be on the title? Yes No What is their name and date of birth?* What is the street address of the home you want a quote on?* What is the city, state, and ZIP Code?* What is your phone number?* What is your e-mail address?* How do you want to receive this quote from us?* Phone E-mail Text Is this a new purchase?* Yes No Is the home currently insured?* Yes No What company currently insures your home?* How many years have you been with that company?* How much are your currently paying for your home insurance? What is your current street address?* What is your current city, state, and ZIP Code?* Who told you about Pilot Insurance Agency?* What date would you need this policy to start? (It generally does take 1 business day for us to complete the quote)* What deductible would you like (this is the amount you pay first if there is a claim, $1000 is the most common)?* $1000 $1500 $2000 $2500 What year was the home built?* What is the above ground square footage?* Is there an attached garage?* Yes No How many stalls in the garage?* 1 2 3 Is there a basement?* Yes No Approximately what percentage of the basement is finished?* What is the foundation?* Slab Crawl Space How many bathrooms are in the house?* 1 1.5 2 2.5 3 How old is the roof (approximately)?* What type of heating system is in the home?* How old is the heating system (approximately)?* When was the electric last updated (if known)?* Does the home have circuit breakers?* Yes No How many stories is the home?* 1 1.5 2 2.5 Bi-level Tri-level Quad-level Is there a wood burning stove on the property?* Yes No Was it professionally installed?* Yes No Unknown Where is it located?* In the home Garage Other outbuilding Do you have a trampoline?* Yes No Does the trampoline have a safety net around it?* Yes No Is the trampoline inside a fenced yard with a locking gate?* Yes No Do you have a pool?* Yes No What type of pool?* Above Ground In Ground Is the pool inside a fence with a locking gate?* Yes No Do you have a diving board or slide?* Diving Board Slide Both Neither Do you have any dogs?* Yes No Please list breed of each dog:* Have they ever bitten anyone?* Yes No Please explain:* Do you have any jewelry or collectibles that you want covered specially?* Yes No Please briefly describe each item and give value of each item:*Do you have a central station burglar alarm (such as ADT)?* Yes No Is there any business operated out of the home?* Yes No Please describe, including whether any clients will come to the home?* This is not required, but if readily available, please upload your most recent insurance policy coverage declarations pages in PDF format so we can see the exact coverage limits you'd like us to compare. These can be easily downloaded from your online profile with your current provider (if you have a login), or from your current agent.Max. file size: 39 MB.Would you like us to also quote your auto insurance so you can get a package discount as well?* Yes No Already have with Pilot Insurance Already entered auto information
