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Use the quick and easy form below to receive free advice regarding Home Earthquake insurance.
First Name
Last Name
Email Address
Address
City
State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
ME
MD
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
Physical Location of Risk, if different than above:
Desired Effective Dates:
Is this a secondary residence?
Yes
No
Is this a rental residence?
Yes
No
Is this a Condo?
Yes
No
Number of Stories:
Total Square footage:
Year Built:
Fair Market Value of Replacement Cost (minus land):
Construction Type:
Frame
Metal
Stucco
Masonry/Brick
Brick Veneer (if over %10)
Joisted Masonry
Concrete Block
Log
Mobile/Modular
Other
Foundation Type:
Continuous Concrete
Concrete Slab
Post and Pillar
Concrete Block
Brick
Basement
Is this structure permanently mechanically attached to the foundation (i.e. bolted)?
Yes
No
Unknown
Is there a masonry fireplace or chimney in the dwelling?
Yes
No
Has any company cancelled, declined, or refused to renew similar insurance, or has there been any quake damage in the last 3 years?
Yes
No
Is there any part of the insured building within 30 feet of a land slope of greater than 30% incline?
Yes There Is
No There Is Not
Is the building foundation on firm, natural ground?
Yes It Is
No It Is Not
While we are preparing your Home Earthquake Quote, if you are also interested in obtaining quotes for other lines of insurance, please select the coverage lines you would like quoted.
Business earthquake
Commercial Equipment
Commercial Property
Life Insurance
Personal Homeowners
Personal Auto
Personal Boat
Personal Renters
Towing Company
Workman's Compensation
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Location
350 NW Elks Drive
Corvallis, OR 97330
Ph: 541-207-1370
Fx: 541-758-2718
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