Homeowner Questions

Bakos Agency Homeowners Insurance Quote:

Please fill out the form below with all the information. All information is required to give an accurate quote. If you cannot answer something please leave it blank, or contact one of our agents to help you. This site is safe and secure for passing personal information.

Name

Address

City

State

Phone

E-mail address

Address of Property

Address

city

State Zip

Current Coverage

Dwelling

Liability

Other Structures

Medical Payments

Personal Property

Loss of use

Deductible Desired

Year Constructed

Number of Family

Construction Type

Frame Stone Masonry Veneer

Questions:

Any other structures, like a garage, or storage building on premise? Yes No

Any insurance discontinued in the last 3 years? Yes No

Are there any other non-central heating devices in use? Yes No

Any other insurance with us? Yes No

Is their a swimming pool on premise? Yes No

Any animals on premise? Yes No

When was the last update for your electrical system? Breeaker Fuse

When was the last update for your plumbing system? Pipe PVC

What was the year of the last roof work?
Shingle Rubber Metal Rolled Roof (Tarpaper)

When was the last update for your heating system?

Cleaned or Maintained once a year? Yes No

Any claims in the last 5 years? Yes No

Who is your responding Fire Deaprtment?

Is this home a townhouse? Yes No

Are their smoke alarms in the home? Yes No

How many?

Do you own any recreational vechiles, like a snowmobile or a boat? Yes No

Additional Comments