503-736-3738

Homeowners Insurance Quote Form


Please complete the following form and click the "Send To " button to submit for a FREE homeowners insurance quote. Jones, Kendall, Sauer, Insurance serves Oregon and Washington. Final premium is subject to verification of information and inspection. All information provided will be held in strictest confidence and used only for the purpose of providing an accurate rate for this specific policy.

Name:

Street Address :

City:   State:     Zip:

Phone Number:

E-Mail Address:

Social Security #

Date of Birth

Your present insurer:

Your expiration date:

Construction Type:

Year Built:

Fire District:

Distance to Hydrant:

Is there a business on the premises?    

Is there a swimming pool on the premises?   

Is there a trampoline on the premises?  

Are there dogs on the premises? 

If yes what breed is the dog? 

Do You Have Fire Extinguishers?:  

Do You Have A Central Station Alarm?:  

Do You Request Flood Insurance?:   

Has property insurance been cancelled, declined or non-renewed in the last 5 years?  

Number of losses incurred in the last 5 years to the insured's home or personal

possessions at this or another location? 

If you have had a claim in the past 5 years please give details:


Amount Of Insurance Requested

Dwelling:

Contents:

Liability:

Deductible Requested:

Please enter any questions or comments below. If you have any items to be scheduled such as jewelry, paintings, silverware, computer equipment etc., please enter item description and value.

 

****To provide a quote with Jones, Kendall, Sauer Inc. the insurance company’s will use information, such as driving record, claims, and credit history, from consumer reporting agencies. ****

 

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