Free Home Owner/Renter Insurance Quote
A RLS Insurance Agent will contact you with a quote within 48 hours.
First Name
Last Name
Street Address
Suite/Apt.#
City
State
Zip
Home Telephone
Email Address
Do you currently have homeowners insurance?
Select One
Yes
No
What is the expiration date of your current Homeowners Insurance Policy?
Do you own or rent?
Select One
Own
Rent
If you own your own home, answer the following questions:
Current insurance value of your Home?
Year Built?
Square Footage
Construction Type:
Select One
Wood Frame
Brick
Masonary
Is there a woodstove in your home?
Select One
Yes
No
Do you have a garage?
Select One
Yes
No
Is it attached?
Select One
Yes
No
If you have a garage, how many car?
Select One
One
Two
Three
What is the distance from a fire hydrant?
Select One
-500 Ft.
-1000 Ft.
+1000 Feet
How many miles to the nearest Fire Department?
Personal Liability Limit?
Select One
$100,000
$300,000
$500,000
Deductible for property coverages?
Select One
$250
$500
$1000
If you rent, answer the following questions:
What is the replacement cost value of your personal items?
What deductible would you prefer for your rental policy?
Select One
$250
$500
$1000
What are your Personal Liability limits for your rental policy?
Select One
$100,000
$300,000
$500,000
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