Property Insurance Quote Request Form Nate Cressall Agency Question Title * 1. Name: Question Title * 2. Please enter your contact information below: House # and Street: City & State: Zip Code: Preferred Phone Number: Preferred Email: Question Title * 3. If you are an educator, at which school are you currently employed? Question Title * 4. Please select which type of property insurance you would like a quote for: Homeowners Insurance Condo Insurance Renters Insurance Course of Construction Policy Question Title * 5. *For Homeowners & Course of Construction Quote Only* Current Coverage A amount (dwelling coverage): Total Square feet (above ground): Basement Square feet: % of BSMT Finished: Garage/Carport Square feet (or # of cars): Type (Attached/Detached/Built-in (living space above): Year built: Question Title * 6. *For Renters & Condo Insurance Only* $15,000 How much personal property coverage would you like? $100,000 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 7. Please select any additional discounts that may apply: NEA Member Discount (OEA, WEA, BEEA, etc) Claims Free Discount (No homeowner claims in the last 3 years) Protective Device Discount (Security System certificate required) Question Title * 8. Do you have any of the following? Yes No Dog(s) with full or partial breed of: Pit Bull, Doberman Pinscher, Rottweiler, Matiff, or Chow? Dog(s) with full or partial breed of: Pit Bull, Doberman Pinscher, Rottweiler, Matiff, or Chow? Yes Dog(s) with full or partial breed of: Pit Bull, Doberman Pinscher, Rottweiler, Matiff, or Chow? No Tar & Gravel Roof? Tar & Gravel Roof? Yes Tar & Gravel Roof? No Trampoline? Trampoline? Yes Trampoline? No Swimming pool? Swimming pool? Yes Swimming pool? No Any business conducted on premises? Any business conducted on premises? Yes Any business conducted on premises? No Wood burning stove? Wood burning stove? Yes Wood burning stove? No Question Title * 9. Please provide current insurance information: Carrier Name: How much do you pay monthly for property insurance? Question Title * 10. Would you like a quote or information for any of the following? Auto Insurance Earthquake Insurance Flood Insurance Boat/RV/Motorcycle/Snowmobile Insurance Life Insurance Retirement Planning Student Loan Forgiveness Submit Property Quote Request