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Year Built

Square Footage

Roof Type

Family Units

# Stories

Exterior Walls

Swimming Pool

How Is The Property Used?

I live there

Secondary/vacation home

I rent it out

A business

Now We Need Some Basic Information About The Policy Holder

First name

Last name

Date of birth

Phone Number

What is your industry?

What is your occupation?

Is the property owned in a trust or LLC?

Name of Trust

Name of LLC

Marital Status

Mailing Address, Same as Property Address?

Yes No

Quotes are estimates only. Quotes are subject to change without notice. Your actual rate, payment and coverage may be different. Quotes do not constitue an offer of insurance, nor is any contract, agreement, or insurance coverage implied, formed or bound by the provision of quotes. Insurability, final insurance premium quotes and an offer of insurance, if any, will be determined by the insurance company providing your insurance policy.
By submitting your information to get a quote, you agree to our Terms of Use.

Click2bind Insurance Services, LLC. License Number in California is 0L01814

Just A Few More Questions To Prepare Your Quotes!

Do you live in a gated community?

Primary Heating Source

Fire Extinguishers?

Yes No

Central Fire Alarm?

Central None

Sprinkler System?

No Yes

Door equipped with deadbolts?

Yes No

Central Burglar Alarm?

Central None

Are there any smokers in the household?

Yes No

Would you like to apply a multi-policy discount for bundling your auto with your home insurance?

Yes No

Just A Few More Questions To Complete Your Application!

Is your property normally occupied during the day?

Yes No

Is the immediate area around your home surrounded by brush or trees or in any areas susceptible to flooding or landslides?

Yes No

Is the property located within the city limits?

Inside Outside

Is there a fuel tank on the premises?

Yes No

Are there any animals on the premises?

Yes No

Please select the type of animal?

Have you had any loss or claim in the last 5 years?

Yes No

# Losses/Claims in the last 5 years

Peril 1 Type Please add value	Peril 1 Claim Date[ 4/20/2021 ] Please add value	Peril 1 Claim Amount Please add value
Peril 2 Type	Peril 2 Claim Date[ 4/20/2021 ]	Peril 2 Claim Amount Please add value
Additional Peril Information

Before We Finish, Are There Any Other Policies You Would Like Quoted??

Would you like a quote on an additional property?

Yes No

Do you own any recreational vehicles such as (snow mobiles, dune buggies, mini bikes or ATVs) that you would like us to quote as well

Yes No

Would you like flood insurance quoted for your property?

Yes No

Do you want a quote for earthquake coverage?

Yes No

Would you be interested in receiving a life insurance quote?

Yes No

Let’s Finalize and Submit Your Application! Please confirm the information below.

We could not verify your address. Please confirm the address is correct before continuing

Real-Time Quotes From A Rated Carriers

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We could not locate your Property! Please complete the fields below to receive your Quote.

Do You Own Or Rent This Property?

Own

Rent

What Kind Of Property Is It?

House

Apartment

Condominium

Townhouse

Other

Other Type

How Is The Property Used?

I live there

Secondary/vacation home

I rent it out

A business

Short Term or Rental

Now We Need Some Basic Information About The Policy Holder

Just A Few More Questions To Prepare Your Quotes!

Do you live in a gated community?

Primary Heating Source

Fire Extinguishers?

Central Fire Alarm?

Sprinkler System?

Sprinkler System Type?

Door equipped with deadbolts?

Central Burglar Alarm?

Are there any smokers in the household?

Would you like to apply a multi-policy discount for bundling your auto with your home insurance?

Select Your Homeowners Coverage

Select Your Condo Coverage

Select Your Renters Coverage

Dwelling Ext. Replacement Cost

Personal Liability

Medical Payments

Water Back-up

Deductible

Condo Building Amount

Personal Property Amount

Personal Liability

Medical Payments

Water Back-up

Deductible

Personal Property Amount

Personal Liability

Medical Payments

Water Back-up

Deductible

Jewelry Value

Fine Arts Value

Camera Value

Musical Instrument Value

Additional Coverage Options

Do you own any jewelry, art, cameras, or musical instruments that are worth more than $1,500?

Thank You For Selecting Your Homeowners’ Coverage! Please Answer The Questions Below To Complete Your Application!

How many Acres is the property located on?

Do you have any uncorrected fire or building code violations for this property?

Is there a trampoline on the property?

Are there tie downs?

Will there be any substantial updates to the property that will occur in the next year?

Have you had any insurance coverage declined, cancelled, or non-renewed during the last 3 years?

Is the property within 300 feet of any commercial property?

Is the property you’re insuring currently up for sale?

Was the property purchased as a foreclosure or short sale?

What is the name of your current insurance company?

What is your current policy’s expiration date?

Any resident employees?

Do you own any other properties?

Number of Additional Residences

Additional Residence Addresses

Any lead paint?

Trust Verbiage

Plumbing, Electrical, Heat, Roof Updated

Roof Improvement Year

Heating Improvement Year

Wiring Improvement Year

Plumbing Improvement Year

We could not locate your Property!
Please complete the fields below to receive your Quote.

Thank You For Selecting Your Homeowners’ Coverage!
Please Answer The Questions Below To Complete Your Application!