Sears & Associates, Inc.

Request a Homeowners Insurance Quote Online:

Please fill out the form below, and we will be in touch with you as soon as possible. Coverage is not bound until you have been contacted by an agent. The more information you provide us, the more accurate the quote will be. Fields marked with * are required.

Note: This information is not being transmitted over a secure server. Feel free to contact our agency if you have any questions.

Full Name:
Property Address:
Home Phone:
* E-mail Address:
Date of Birth:
Employer's Name:
How many years with this employer?
Previous Employer (if with current employer less than two years):
Highest Level of Education:
Spouse's Full Name:
Spouse's E-mail Address:
Spouse's Date of Birth:
Spouse's Employer:
How many years with spouse's employer?
Spouse's Previous Employer (if with current employer less than two years):
How many years at this address?
Previous Address (if at current for less than two years):
Roommates?
Security System?
If yes, security system company name:
Dead bolts on all outside doors?
Fire extinguishers?
Smoke detectors?
Insurance History:
Prior Insurance Company:
Expiration of Current Policy:
Claims Filed:
Home Information:
Year Built:
Exterior Material:
Foundation:
Number of Stories:
Basement?
Square Footage:
Fireplace/Stove?
Heating System:
Number of Full Baths:
Number of Half Baths:
Balcony or Deck Square Footage:
Garage?
If yes, how many cars?
Attached/Unattached:
Additional Information:
Is business conducted on the premises?
If yes, please explain:
Are there full-time residence employees?
Are there dogs on the premises?
If yes, have they bitten anyone?
Is there a swimming pool on the premises?
If yes, where is it located:
If yes, is it fenced?
Nearest fire hydrant:
Miles to nearest fire department:
Notes/Special Instructions:

By clicking submit, you agree that you have read and understand our privacy policy. Coverage is not bound until you have been contacted by an agent.