Homeowners)Insurance)Quote)Sheet)

Homeowners Insurance Quote Sheet

Name of Insured(s)______________________________________________________________ Phone number_____________________ E-mail address__________________________________________________________________ Address___________________________________ City_________________ County________________ Zip Code__________________ 1st Named Insured DOB_______________ SS#__________________________ Current Insurance is with_________________________ 2nd Named Insured DOB______________SS#___________________________ Policy Expiration Date__________________________ A copy of your current policy declarations page would be helpful for you to send to us as well. Current Dwelling amount________________________ Liability Limit_____________________ Deductible_______________________ Scheduled Items: Jewelry $____________ ; Other_____________ $___________ We will need appraisals and or receipts for each item Construction Type:_________________ Style of Home______________ What type of siding __________________, Roof______________ Any Stucco______ #of Stories_________ Square footage per floor_____________ Basement __________Finished or Unfinished_________ Garage ? Detached or attached or tuck under # of Stalls___________ Any dogs and what Breed(s)_________________________________ Pool or Hot Tub_____ Diving Board_______ Is the pool area fenced in and locked? ___________Trampoline_______ Deck____ sq. ft.___________________ Deck____________ Sq.Ft.____________ Original year home was built_______________ Fireplace ______ # of Chimney's______ # of Bedrooms ______ # of Baths_______ Year Purchased_________ Purchase Price__________ Year Roof replaced __________________ Year wiring updated_________________ 100 or 200 amp service or Fuses?________________ Year plumbing was updated_________________ Year Heating A/C updated_______________ A/C Central or windows?_______________ Any other special features in the home?_________________________________________________________________________________ Security System _____________ What Type ______________________Central Alarm credits require an alarm certificate from alarm company

Do you own any watercraft? _____ Year__________ Make___________ Model______________ Length_____________ Inboard ? Outboard- Inboard/outboard Horsepower_____________ (#cc's) Equipment $ amount___________________________ Boat VIN__________________________ Motor VIN________________ Trailer Value _______________VIN_______________________ What waters do you navigate?____________ Where is craft docked?_________ Drivers license #___________________________ Do you own any snowmobiles?________ Four wheelers?__________ Three Wheelers?______________________________ Year_______ Make________Model_______________ Primary home_______ Secondary____________ Fire Dwelling________ Mobile Home_____ Renters Insurance________________ How did you find out about us?___________________________________________________________________________________

Notes:______________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Information taken by________________ Date received____________________

Array Insurance 2500 Mendelssohn Ave N, Golden Valley, MN 55427

Voice:763--504--3067

Fax: 763--504--3011

E--mail: Arrayinfo@

rev 10/13

Array Financial Services 2500 Mendelssohn Ave N Golden Valley MN 55427 763-504-3067 phone, 763-504-3011 fax Email: arrayinfo@

Automobile Worksheet

Insured ? Full Name

Sex :

DOB:__________

Home address: ___________________________________________________________________

City:

State:__________________zip: ___________

Home phone:__________________cell phone:_________________email:___________________

Drivers License#

motorcycle endorsement:_______________________________

S.S.#___________________________________________________________________________

Occupation:______________________Place of employ:_______________________________

2nd insured ? Full Name

Sex :

DOB:__________

Drivers License#

motorcycle endorsement:_______________________________

S.S.#___________________________________________________________________________

Occupation:______________________Place of employ:_______________________________

3rd insured ? Full Name

Sex :

DOB:__________

Drivers License#

motorcycle endorsement:_______________________________

S.S.#___________________________________________________________________________

Occupation:______________________Place of employ:_______________________________

If there are more drivers in the household please list them as well.

VEHICLE INFORMATION: Yr/Make/Model________________________________Vin:_________________________ Yr/Make/Model________________________________Vin:_________________________ Yr/Make/Model________________________________Vin:_________________________ Yr/Make/Model________________________________Vin:_________________________

Current Insurance Co:_________________________How long:_______________________

Current Limits per vehicle _________________________________ Defensive Driver course_______________date taken_____________________ Do you own a home?___________________Do you have any recreational vehicles?

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