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Step 1 of 12 - Start

Thank you for your interest in receiving a homeowners quote from Charles Alexander Insurance. This form should only take about 5 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.

Name*

Insured First Name Insured Last Name

Mobile Phone*

Email*

Date of Birth*

Occupation*

Please specify other occupation

Date you want this policy to start*

MM slash DD slash YYYY

Personal Information

Marital Status*

Children in household (under 18)*

Significant Other Name*

First Last

Significant Other Date of Birth*

Significant Other Phone

Significant Other Email

Significant Other Occupation*

Significant Other: Please specify other occupation

Property Information

Is this for a home closing?*

Property Address?*

Street Address Unit Number City State ZIP Code

Is the property titled in a name other than your personal name(s)?*

(i.e. Trust, LLC, Corporation, etc.)

Yes

Name on title of property*

Do you have a mortgage on this property*

Yes

Who is responsible to pay for the homeowners insurance?*

I pay for the insurance

My mortgage company pays the insurance

Would you like to enter your mortgagee information now?*

You can upload a copy of your current policy later if you don't want to enter your mortgagee information now.

Yes, I'll enter my lender information and loan number

Not right now

Mortgagee Name

Mortgagee Address

Mortgagee Address (Line 2)

Loan Number

Residence Type*

Type of Home*

Home Width (ft)

Home Length (ft)

Manufacturer

How often do you plan on staying at this secondary home?*

Do you have a property manager?*

Yes

Name of property management company or caretaker

Property Information

Year Home Built*

Construction Type*

Exterior Walls*

Number of Stories*

Is there a rental unit on the property?*

Yes

Rental unit is*

Attached

Detached

Rental Unit Usage*

Roofing Material*

Roof Design*

Does the roof have any solar panels?*

Yes

How many solar panels*

Current value of solar panels*

Do you know when the roof, plumbing, electrical, or exterior paint was updated?*

Yes

I don't know

Year Roof Updated*

Year plumbing updated*

Year electrical updated*

Year ext. paint updated*

Purchase Date*

Purchase Price*

Mailing Address

Mailing Address*

Same as Property Address?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of years at this address

Previous Address*

Street Address City State Zip Country

Replacement Cost

We need this information to determine how much it would cost to rebuild this property in the event of a loss.

Has the electrical or plumbing on your condo been updated? If so what year(s)?*

Foundation Type*

Square Feet*

Basement?*

Yes

Sq Ft of Basement

% Basement Finished

Garage*

What type of other garage does the property have?*

Full Baths*

Half Baths*

Bathroom Grade*

Kitchen Grade*

Cooling / Air*

Primary Heat Source*

Fireplace Types*

None

Wood burning fireplace

Gas fireplace

Wood stove

How many of each type of fireplace?

Deck*

Deck Sq Ft*

Upload Current Policy

To better assist us in comparing your current coverage to our proposal, please upload a copy of your current homeowners policy.

Would you like to upload a copy of your current homeowners policy?*

Yes

Name of current insurance carrier*

Why we need this: We represent many different carriers and we don't want to quote your insurance with the same carrier.

When does your current policy expire?

Current Policy Upload*

You may upload up to 10 policy documents. Only .pdf file types accepted.

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 10.

Claims and Rating Information

Liability Limit

Dwelling / Improvements Coverage*

Contents Coverage Amount*

Loss of Use Amount*

Reported Claims (last 3 years)*

Have you had any insurance lapse (30 days or more), cancel, or non-renew in the last 3 years?*

Yes

No prior insurance

Optional Discounts

The following discounts are available. Please check all that apply.

Central Station Fire Alarm

Central Station Burglar Alarm

Water Leak Sensors

Home Security System (Cameras, RING, etc.)

Smart Home

Multi-Policy Discount (Auto + Home)

Paperless Billing

My property is unique

Please let us know what unique features this property has (ie. elevator, backup generator, server room, etc.)

More Property Info

Great job! Keep going.

Do you have any pets?*

Yes

Please list all your pets. If you have dogs please list the breed(s).

Does this property have a pool?*

Yes

Pool Options*

Is the property situated on less than 5 acres?*

Yes

Is there a trampoline on the property?*

Yes, with netting

Yes, without netting

Do you conduct business out of your home?*

Yes

Please describe your operations*

Scheduled Items

Most homeowners policies have limitations on the following types of personal property. You have the option to schedule (or add) these special items to your policy for higher coverage.

Examples of these types of items include: jewelry, furs, art, collectibles, cameras, computers, golfing equipment, guns, antiques, silverware, bicycles, coins, musical instruments.

Do you have any items you would like to schedule?*

Yes

Please describe your items

Last Step

You're almost done!

Would you like to receive an auto quote as well to maximize your savings?*

Yes

Let's discuss

Would you like a quote from a specific agent?

How were you referred to us?

Is there anything you want us to know?

Consent*

Like most insurance agencies, [agencyname] uses information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium.

I Agree

All the above information is accurate and true to the best of my knowledge.*

Yes

Would you like to create a user account to manage your submissions?*

Yes, create my account

Not at this time

Username*

Create a Password*

Enter Password Confirm Password

Phone

This field is for validation purposes and should be left unchanged.

Personal Information

Property Information

Property Information

Mailing Address

Replacement Cost

Upload Current Policy

Claims and Rating Information

Optional Discounts

More Property Info

Scheduled Items

Last Step

Charles Alexander Insurance Group

Social Media

Start a Quote

Helpful Links

For Clients

Get a Homeowners Insurance Quote

Personal Information

Property Information

Property Information

Mailing Address

Replacement Cost

Upload Current Policy

Claims and Rating Information

Optional Discounts

More Property Info

Scheduled Items

Last Step

Charles Alexander Insurance Group

Social Media

Start a Quote

Helpful Links

For Clients