Penwell Insurance

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Homeowners Insurance Quote Form

Thank you for giving us the opportunity to earn your business. Below is our quick Homeowners Coverage quote form. Please fill out all fields and click the submit button to proceed.

Please note: Accurate information speeds up the quotation process. Also, all information collected from the forms on this site is considered confidential to penwellins.com and will not be sold or given to any third-party under any circumstance. Once your information has been received, you will be contacted as soon as possible by one of our specialized insurance consultants to discuss your personalized insurance quote.

Information provided to Penwell Insurance is secure and encrypted to protect your information. Penwell Insurance does not sell information, and the information received will not be used for any other purpose than to provide an insurance quote.

Required fields marked *

About You

1. *First Name
2. *Last Name
3. *Phone (xxx-xxx-xxxx)
4. Social Security Number
5. E-mail Address

Information on the Home

1. *Address
2. *City
3. *State Illinois Indiana
4. *Zip
5. County of Residence
6. Township
7. Date of Birth
8. Are You Currently Insured? Yes No
9. Current Carrier:
10. How Long With Carrier?
11. Any prior Home/Renters Insurance Cancelled? Yes No
12. Home Square Footage (Excluding Basement)
13. Year Your Home was Built
14. Exterior Construction Stone Stucco Brick Mobile / Prefab Vinyl Siding Aluminum Cement Board Other Please Select
15. Number of Stories 1 2 3
16. Number of Full Baths 1 2 3 4 5 6
17. Number of Half Baths 1 2 3 4
18. Number of Fireplaces 1 2 3 4 0
19. Garage Size No Garage 1 Car Garage 2 Car Garage 3 Car Garage 4 Car Garage Car Port
20. Estimated Value of Home
21. Have You Filed a Claim in the Last 5 Years? Yes No *Please explain

Home Details

1. Basement Yes No
2. What percentage is finished?
3. Air Conditioning Yes No
4. Wood Burning Stoves Yes No
5. Screened in Porch or Patio Yes No
6. Pool Yes No
7. Is the Pool Fenced In? Yes No
8. Trampoline Yes No Is the Trampoline Fenced In? Yes No
9. Pets Yes No Describe of your pet(s)
10. Smoke Alarm(s) Yes No
11. Central Alarm System Yes No
12. Closest Fire Hydrant 500 Feet 1000 Feet 2000 Feet None
13. Miles to Closest Fire Department

Optional Coverages

1. Optional Coverages (i.e. jewelry, guns, collectibles, sewer & drain backup, earthquake, etc.)

Coverage Limits

1. Dwelling / Home Amount
2. Liability 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000
3. Medical Payments to Others 1,000 2,000 3,000 4,000 5,000
4. Deductible 100 250 500 1,000 2,500 5,000

General Information

1. How Did You Hear About Us? Facebook Twitter LinkedIN Event / Sponsorship Magazine Newspaper Referred By Friend Search Engine Walk-In Website Advertisement Yellow Pages
2. If referred by someone, please state their name
3. Additional Information

Send Home Insurance Quote

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