McCashland Kirby Insurance Agency Inc. Homeowners and Renters - McCashland Kirby Insurance Agency Inc.

Insurance Overview

Name*

First Last

Email

Phone

Date of Birth*

Preferred Method of Contact

Social Security Number

How did you hear about us?*

Referral
Internet
Other

Referral Name or Business Name*

Home
Condo
Renter

Property Address

Address*

Street Address Address Line 2 City State ZIP Code

Is your mailing address same as your property address?

Address*

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

Home Details

Year Built*

Is this house a primary or secondary residence?

Is this a multi-family home?

Construction Type

Roof Type

Dwelling Replacement Cost Limit*

Protection Information

Fire Station within 5 miles

Fire Hydrant within 1,000 feet

Deadbolts

Smoke Alarms

Fire Extinguishers

Is there a smoker in your home?

Home Burglary System

Protection Information

Do you currently have home insurance?

Desired Coverage

Deductible

$500
$1,000 (most common)
$2,000
$5, 000

Medical Payments

$2,000
$3,000
$5,000

Personal Liability

$300,000
$500,000 (most common)

Dwelling Replacement Cost

Content Replacement Cost

Valuables

Please list monetary values for the following valuables:

Jewelry

Camera

Silver

Furs

Guns

Golf Equipment

Fine Art

Musical

Stamps

Please list monetary values for items vaulted and not vaulted.

Items Vaulted

Items NOT Vaulted

Personal Information

First Name*

Last Name*

Date of Birth

Years at Current Address*

Home

Do you have an auto policy?