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Please
take a second to read our disclaimer before continuing:
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A
& J Insurance Agency does not express or imply any insurance
coverage by your completing the quote request form or by our
responding with a price comparison. Coverage can only be obtained
upon completion of a company-approved application and with receipt
of the appropriate premium down payment.
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Home
/ Renters / Condo Insurance Quote Form (Nevada Only)
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To
request a quote, please complete the form entirely. If currently
insured, your policy's declaration page will have much of the
needed information. All items marked with a red tag  are
required to be completed:
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| General
Information: |
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First Name:
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Last
Name:
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Address:
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City,
State & Zip:
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Phone
Day / Eve:
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Fax
number:
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Best
time to call (eg, "after 2pm"):
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Email:
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Do
you own or rent your home:
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Current
homeowner coverages:
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Dwelling
amount (value):
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Liability
limit:
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Medical
Payments:
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Deductable:
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Construction
type :
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Type
of House:
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Year
built
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Distance
to Fire Hydrant:
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(feet) |
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Distance
to Fire Station:
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(miles) |
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Number
of Stories:
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Ground Floor Square Footage:
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Total Square Footage (excluding garage):
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Garage
Select:
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Alarms:
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Number
of Bathrooms:
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Number
of Fireplaces:
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Central
Air:
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Decks
(total square feet):
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Porches
(total square feet):
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Pool:
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If
you are interested in flood or earthquake coverage, please check.
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| Pets,
Please list breed of dogs and any exotic pets in comments section. |
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| Any
claims in the last 3 years? Give details in comments section. |
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Are
there any additional comments that are important in quoting
your home?
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Deliver
quote VIA:
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Phone
Fax
E-Mail
Mail
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| Click
below to submit for quote: |
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