Homeowner Quote

Please Complete the Form Below

If you have any questions, please reach out to Tim Miles at 480-985-7745 or email him at tim@valleyig.com.

Applicant Information:

Applicant Full Name

Applicant Date of Birth

Applicant Occupation

Applicant Phone

Applicant Email

Co Applicant Information:

Co Applicant Full Name

Co Applicant Date of Birth

Co Applicant Occupation

Co Applicant Phone

Co Applicant Email

Trust or LLC

Primary Home Address:

Primary Address:

Address of Premises if Different

Current Insurance Carrier:

Current Insurance Carrier

Policy End Date

Any Home Claims in the past 5 years

Claim Amount

If Yes, Please Explain

Home Details:

Home Use

Primary Secondary Seasonal Short Term Rental

Build Year

Purchase Price

Purchase Date

Square footage

Separate Structure Square Footage

Separate Structure Use

Rental Usage

Construction Type

Frame Log

Siding Type

Log Fiber Cement Wood Other

Siding Type - Other

Interior Design

Standard Semi Custom Custom

Heat/AC Type

Fireplace/Stove

Fireplace Gas Fireplace Wood Stove Pellet Stove

Roof Type

# of Bedrooms

# of Bathrooms

# of Stories

Distance to closest Fire Hydrant

1000 feet 1000 feet or more

Distance to Nearest Fire Department

Monitored Alarm System & Provider

Home Updates/Renovations Year

Other Updates