Orange Insurance | Homeowners, Renters Insurance Quote
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Homeowner's or Renter's Insurance Quote

Rates As Low As $75/year!
(financing available with small down payments)

Homeowners & Renters Information:
Homeowner's or Renter's Full Name:
Physical Address (P.O. Boxes Not Accepted):
City:
State:
Zip Code:
Phone Number:
Email Address:
Social Security Number (Your Privacy is Protected):
[to get you the best rate]
 
Date of Birth:
Gender:
Marital Status:
Highest Completed Education:
Occupation:
Dwelling Type:
Single-Family Townhome Condo Apartment Other:
Policy Type:
Homeowners Renters Landlords Condo
Dwelling Coverage Amount:
Personal Property Coverage Amount:
Personal Liability Coverage Amount:
Water Back Up Coverage Amount:
Year Built:

Purchase Date
:

Purchase Price:
Number of Units in Complex if Townhome, Condo or Apartment:
Number of Stories (Homeowners and Renters):
Dwelling Type (Ranch, Colonial, Contemporary, Etc.):
Exterior Wall Construction Type (Frame, Masonry, Steel, Etc.):
Siding Type (Aluminum, Cedar, Shake, Etc.):
Roofing Type (Tar, Shingle, Metal, Etc.):
Fireplace:
Yes No
Single-Sided Double-Sided
1 Fireplace 2 Fireplaces 3 Fireplaces 4+ Fireplaces
Wood Burning Stove:
Yes No
Number of Rooms:
Bedrooms
Full Bathrooms
Half Bathrooms
Foundation/Basement:
Slab Piers Unfinished Partially Finished Fully Finished
Garage:
Yes No
Attached Detatched Carport
1 Car 2 Car 3 Car 4+ Car
Covered Patio/Deck:
Yes No
Swimming Pool:
Yes No
Trampoline:
Yes No
Tennis Court:
Yes No
TOTAL Square Footage (of Home or Building):
Square Footage Your Unit Occupies (If Applicable):
Vacancy Percentage (If Multiple Residence Building):
%
Date That The Electrical, Heating, Plumbing & Roofing Was Updated (If Applicable):
Electrical
Heating
Plumbing
Roofing
Wiring Type:
Copper Knob & Tube
Service Panel Circuit Breakers:
Yes No
Heating Type:
Central Gas Baseboard Radiant (Electric) Radiant (Water)
Oil w/Tank Propane w/ Tank
Central Air Conditioning:
Yes No
Safety (Check if You Have):
Burglar Fire Smoke Deadbolt Fire Extinguisher
If you checked any of the above for Buglar, Fire and/or Alarm, are they professionally monitored?
Yes No
Is There A Fire Sprinkler System:
Yes No
Distance to Fire Hydrant (Feet or Miles):
Distance to Fire Station (Feet or Miles):
Distance to Coastal Waters (Feet or Miles):
Pets:
Yes No
Breed
Jewelry or Other Scheduled Items:
$
Is There A Business On Site:
Yes No
Business Type
Mortgagee (Bank) and/or Additional Interest:
Yes No
Mortgagee Name
Address
Loan Number
Additional Information:
Additional Comments:
Please let us know how you found us:
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[ © 2010-2017 Orange Insurance® LLC ] [ WAOIC# 774768 | Bond# 6741497 ] [ Corporate Headquarters: Seattle, WA. ] [ 877.288.6103 ] [ email ]

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