Douglas Bays & Associates
Homeowners Insurance Quote Form
For the fastest and most accurate homeowners insurance quote, please provide as much information possible in the form below. This information will be kept confidential and will be used for quote purposes ONLY!
General Information
Name:
Address:
City:   State:    ZIP:
County:   Email:
Phone (Day): (Optional)          Phone (Evening): (Optional)
Current Homeowners Insurance Company (not agency):
Company Name:
Policy Exp. Date: / /
Amount Insured For: $
Home Information
Sq. footage of home (excluding
garage and basement):		 Year home was built:
Structure Information
Type: Construction: Roof: Foundation: Garage:
  Age of roof:   yrs.  
Features
Bathrooms: Basement: Deck/Porch/Patio: Fireplaces: Electrical:
  # of Full:  
  # of Half:  
Sq. Ft: 		Deck Sq. Ft:  
Porch Sq. Ft:  
  Screened Patio Sq. Ft:   		 # of Chimneys:  
 # of Hearths:  


Amps:

Additional Features
Heating System: Central Air: Central Vac: Security Alarm: Fire Alarm: Smoke Detector:
yes
no 		 yes
no 		 yes
no 
Pool: Pets: Breed of Pet, if any: Current Deductible: Prior Claim in Last 5 years?  
yes
no 		 yes
no		 yes
no 		  
Additional Comments:
Please give any additional comments about the coverage you desire:
 

Thank you for your quote request!
A Douglas Bays & Associates representative will respond to your submission as soon as possible!

This form is a request for a quotation, not an insurance policy. The quote is based on the information provided and could change after further review of applicable information.

Quality Service You Can Count On.
Return to Douglas Bays Home Page