Homeowners/Property Insurance Quote

Please fill out form completely and we will contact you shortly. Thank you.

Personal Information
Name First Last
Mailing Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
How long at present address?
Phone - (###) - ### ####
Best time to call?
Email
Occupation
Insurance Information
Is property address different than mailing address, if so:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Current Homeowners Insurance Company:
Policy Expiration Date: / MM / DD YYYY
Current annual premium:
Amount of Dwelling coverage:
Amount of contents coverage
Home Information
Year built:
Square Footage:
Number of claims in last 3 years
Occupancy
Type of Occupancy: Primary Secondary Seasonal Rented-primary Rented-seasonal
Number of months occupied:
Structure Information
Type of Structure? Home Condo Mobile Home (if selected - please fill additional information below)
Number of floors? 1 Story 2 Story Other
Type of Construction? Frame Masonry Superior
Roof Construction Shingle Tile Metal Tar/gravel
Age of roof:
Foundation Slab Pillar/piers
Number of full Bathrooms?
Full

Half
Deck/Porch/Lanai Deck Square Footage
Porch Square Footage
Lanai Square Footage
Fireplaces: Yes No
Central Air: Yes No
Pool: Yes-caged Yes-fenced No pool
Number of Garages: 0 1 car 1.5 cars 2 cars 2.5 cars 3 cars
Garage Type: Attached Detached No Garage
Burgular Alarm: None Monitored Non-monitored
Fire Alarm: None Monitored Non-monitored
Shutters: Yes No
Any Animals: Yes No
Type of animals and breed:
Any bite history: Yes No
If yes, explain:
Mobile/Manufactured Home Information (if applicable)
Make/Model:
Serial Number:
Length and Width:
Name of Park:
Mortgagee Information (optional)
Mortgage Holder:
Mortgage Name

Address Line

City

State / Province / Region

Postal / Zip Code

Country
If new purchase, expected closing date:
Purchase price:
Escrowed? Yes No
Any additional information:
How did you hear about Key Agency?
Do you need to insure any jewelry, fine arts, silver, furs or firearms? Please list:


BOCA GRANDE, FL 428 4th Street West, Unit B Boca Grande, FL 33921 Tel: 941.964.1500 Fax: 866. 224.1422 E-mail this office	ENGLEWOOD, FL 1201 S. McCall Rd. Englewood, FL 34223 Tel: 941.474.9511 Fax: 941.474.7283 E-mail this office	NORTH PORT, FL 14942 Tamiami Trail Suite H North Port, FL . 34287 Tel: 941.429-9709 Fax: 941.429.0287 E-mail this office

Key Agency, Inc., Independent Insurance Agency
Family Owned & Operated Since 1952

For all your

Insurance needs

Key Agency, Inc. will provide you with a no cost,
no obligation review and comparison of your insurance.

Homeowners/Property Insurance Quote

Homeowners/Property Insurance Quote

Personal Information

Insurance Information

Home Information

Occupancy

Structure Information

Mobile/Manufactured Home Information (if applicable)

Mortgagee Information (optional)