Contact Us: (541) 770-3383
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Homeowner Insurance Quote
Contact Us
(541) 770-3383
1091 Medford Center
Medford, OR 97504
Click Here to Email Us
*
Indicates required field
Type of Home
*
Single Family Home
Duplex
Townhome
Mobile Home
Other
Year Built
*
Construction Type
*
Mostly Wood Frame
Mostly Brick
Stucco
Other
Foundation
*
Bsmt Fully Finished
Bsmt Half Finished
Bsmt Unfinished
Crawlspace
Slab
Other
Roof Type
*
Asphalt Shingle
Tile
Concrete
Other
Roof Age
*
Under 5 Years
5-10 Years
Over 10 Years
Garage Type
*
Attached - 1 Car
Attached - 2 Car
Attached - 3 Car
Attached Car Port
Detached - 1 Car
Detached - 2 Car
Detached - 3 Car
Detached Car Port
No Garage
Other
Fire Alarm
*
None
Monitored
Unmonitored
Not sure
Square Footage
*
Primary Heating
*
Gas (Forced Air)
Electric
Hot Water Radiator
Oil/Coal/Karosene
Propane
Stove
Bedrooms
*
1
2
3
4
5
6
7+
Bathrooms
*
1
1.5
2
2.5
3
3.5
4+
Stories
*
One Story
Bi Level
Two Story
Tri Level
Other
Security System
*
None
Monitored
Unmonitored
Unsure
Municipal Location
*
Inside City Limits
Outside City Limits
Not Sure
When would you like this policy to start?
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Select any additional property features that apply.
*
Dead Bolts
Fire Extinguishers
Tramploline
Covered Deck/Patio
Swimming Pool
Have you reported any claims or losses to your insurance company within the past 5 years?
*
Yes
No
Is your home located in a flood plain?
*
Yes
No
Not Sure
Do you have any of the following breeds of dogs: Chow, Doberman, German Shepherd, Pit Bull, Rottweiler, Wolf Hybrid, or a mix of these?
*
Yes
No
Approximate Replacement Cost of Dwelling (not including land)
*
Personal Liability Coverage Desired
*
$100,000
$300,000
$500,000
$1,000,000
Other
Desired Deductible
*
$250
$500
$1000
$2000
Other
Will this insurance replace an existing policy?
*
Yes
No
Credit Rating
*
Excellent
Good
Poor
Unsure
Name
*
First
Last
Email
*
Phone Number
*
Additional Comments?
*
Submit