Alternatives Insurance of O'Fallon and Troy Missouri

Customer Information

To help get a more accurate quote. Please fill out as much of this information as possible.

All of our companies will partially base their rates & discounts on a credit score. By filling out the quote information you are giving permission for the insurance companies to check your credit with a soft hit credit check.

Name:
Customer Email: Address:
Phone Number:
Date of Birth:
How long at current address?

New Purchase Details (if applicable)

New Purchase Address:
Approximate Move-In Date:

Spouse Information (if married)

Spouse Name:
Spouse Date of Birth:

Home Information

Does anyone smoke in the home?
Year Built:
Number of Stories (excluding basement):
Total Square Footage (excluding basement):
Is there a basement?
If yes, percentage finished:
If no basement, home is on:
Is there an attached garage?
If yes, how many cars?
Number of Bathrooms:
Is there a fireplace?
If yes, how many?
Is there a wood-burning stove?
If yes, was it professionally installed?
Is there a deck?
If so, dimensions/square footage:
Age of the Roof:
Type of Roofing Material:
Electrical System:
Age of the Furnace:
Current Value of the Home:
Do you have any pets or farm animals?
If yes, what kind and how many?
Do you have a pool?
If yes, is your yard fenced?
Do you have a hot tub?
If yes, is your yard fenced?
Do you have a trampoline?
If yes, is it anchored down?
Does it have a net?

Fire Safety Information

Distance to Closest Fire Department (miles):
Is there a fire hydrant less than 1000 feet from your house?

Insurance and Claims History

Any claims in the last 5 years?
If yes, describe type of claims and when:
Are you currently insured?
If yes, with who?
How long have you been insured?
Current Deductibles:
Do you currently have Earthquake coverage?
Do you currently have Sewer backup coverage?

Mortgage Information

Do you have a Mortgage?
If yes, Does your Mortgage escrow your Insurance payment?
CAPTCHA (prove youre human!): What is 2+2?

	(636) 978-7260
	O'Fallon

	(636) 462-1778
	Troy

	leeann@alternatives.group
	(O'Fallon) Leeann Engel

	brian@alternatives.group
	(Troy) Brian Engel