Home Insurance

For a Home Insurance Quote, please fill out the entire form below. If you encounter any issues, please call us at 913-768-0008 or info@irgks.com.

Personal Information

Name *

Date of Birth *

Address *

City *

State *

Zip *

Home Phone Number *

Work Phone Number

Email Address

Have you had continuous coverage for at least 12 months? Yes No

If not, why not?

Present Insurance Company

Present Coverage Amount

Renewal Date

Occupation

Claims in Last 3 Years    0    1    2    3    4+

Home Information

Square footage of living space

Year home was built

Electrical updated? Provide date.

Plumbing updated? Provide date.

Furnace updated? Provide date.

Type    1-Story    1 1/2-Story    2-Story    Split Level

Construction    Frame or Stucco    Masonry Veneer    Masonry

Foundation    Basement    Crawl Space    Slab

Roof    Asphalt Shingle    Wood Shingle    Tile or Slate    Other

Age of roof

Garage Size    1-Car    2-Car    3-Car    4+ Car

Full bathrooms    1    2    3    4    5+

Half bathrooms    1    2    3    4    5+

Other features    Central Air Conditioning   Wet Bar   Security System   Whirlpool Tub

Number of chimneys    1    2    3    4    5+

Number of hearths    1    2    3    4    5+

Basement    Yes    No

Deck square feet

Porch square feet

Screened Patio square feet

Enclosed Patio square feet

Comments

Comments

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