What is the zip code of the home you are insuring?
Is this home a new purchase?
Yes
No
Are you currently insured, or have you been insured in the last 30 days?
Yes
No
What is your current insurance company?
--Select--
AAA
AIG
Allied
Allstate
American Family
Amica
Farm Bureau
Farmers
GEICO
Hartford
Liberty Mutual
Metropolitan Co.
Nationwide
Progressive
SAFECO
State Farm
Travelers
United Services Automobile Association
Unitrin Direct
Other Company (Not Listed)
Other Company (Not Listed)
AAA
AABCO
Acceptance
Access Insurance
Acordia
Aegis Security
AETNA
Affirmative
AIG
AIU
Alliance for Affordable Services
Allied
All Nation
All Risk
Allianz
Allstate
Amalgamated Life Insurance
AMCO
America's Ins. Consultants
American Alliance
American Banks
American Economy
American Empire Group
American Family
American General
American International Group
American Investors
American National
American Premier
American Reliable
American Republic
American Standard
American States
American Sterling Insurance
American Underwriters
American United Life Insurance
Amerisure
AmerUs Life
AmwestInsurance Group
Amica
API
Arbella
Arizona General/option>
Assigned Risk
Association Field Services
Associated Indemnity
Assurity LIfe
Atlanta Casualty
Atlantic Indemnity
Austin Mutual
Auto Owners
Avomark
Badger Mutual
Bankers & Shippers
Bankers Life and Casualty
Beneficial Life Insurance
Berkshire Life Insurance
Blue Cross/Blue Shield
Bonneville
Boston Old Colony
Builders
Cal Farm
California Casualty
California State Automobile Association
Camden
Capital Choice
Care Entrie
Cascade National Ins
Casualty Assurance
Centennial
Charter Oak
Chicago Insurance
Chubb
Church Mutual
Cigna
Citizens
Clarendon American
Cloverleaf
CMA
CMA Alliance
CNA
Colonial
Combined
Commercial Union
Commonwealth
Continental
Cotton States
Cottonwood
Country Financial Services
Country Insurance
Credit Union
Criterion
CUNA Mutual
Dairyland
Dakota Fire
Deerbrook
Depositors Emcasc
Dixie
Ebco General
Economy
Electric
EMC
Empire
Employers Fire
Ensure
Equitable
Erie Insurance
Facility
Farm Bureau
Farmers
Farmland
Federal
Federated
Fidelity
Financial Indemnity
Fire and Casualty Co of CT
Fireman's Fund
First American
First Colony
First Financial
First General
First National
Ford Motor Credit
Foremost
Fortis Group
Franklin
Golden Rule
GEICO
GE Financial Network
General Accident
Gerber Life Insurance
Globe
GMAC
Golden Rule
Government Employees
Grange
GRE
Great American
Great Way
Great West
Grinnell Mutual
Guaranty National
Guardian
Guide One
GEICO
Halcyon
Hanover Lloyd's Company
Happy Days
Hartford
Hawkeye Security
Health Net
Health Plus of America
Heritage
Horace Mann
Humana
IDS
IFA Auto
IGF
Infinity
Insurance of Evanston
Integon
Interstatey
John Deere
John Hancock
Kaiser Foundation Health Plan
Kemper Lloyds
Kemper Insurance
Kentucky Central
Landmark American
Landmark Life Insurance
Leader General
Leader National
League General
Liberty Mutual
Lincoln Financial Group
London Life Insurance
Lumbermens Mutual
Managed Comp
Marathon
Markel American
Maryland Casualty
Mass Mutual
MBA Insurance
Mendota
Mega Life and Health Ins.
Merastar
Mercury
Met Life
Metropolitan Co.
Mid Century
Mid-Continent Casualty
MidWest Mutual
Mid-West Ntl. Life
MidCentury (Farmers)
Midwest Mutual
Middlesex
Millbank
Millers Mutual
Milwaukee
Milwaukee Guardian
Milwaukee Mutual
Minnehoma
Missouri General
Modern Woodmen of America
MONY Group
Motors
Mountain Laurel
MSI
Mutual of Enumclaw
Mutual of New York
Mutual Of Omaha
N.A.S.E.
National Alliance
National Assoc - Self Employed
National Colonial
National Continental
National Farmers Union
National Health
National Indemnity
National Merit
National Surety Corp
Nationwide
New England Financial
New York Life
North American
North Pacific
Northe Pointe
North Shore
Northern Capital
Northern States
Northland
Northwestern
Northwestern Mutual Life
Ohio Casualty
First Security
Olympia
Omaha
Omni
Oregon Mutual
Orion
Oxford Insurance
Pacific
Pacific Life Insurance
Pafco General
Paloverde
Pan-American Life Insurance
Patriot General
Peak Property and Casualty
PEMCO
Penn America
Penn Mutual
Pennsylvania Natl
Phoenix
Pinnacle
Pioneer Life
Preferred Abstainers
Preferred Risk
Premier
Prestige
Primerica
Principal Financial
Progressive Insurance
Protective Casualty
Protective Life
Provident Corporation
Quality
RBC Liberty Insurance
Ramsey
Ranger
Regal
Reliance
Reliant
ReliaStar Life
Republic Indemnity
Response
Rockford Mutual
SAFECO
Safeway
Savings Bank Life Insurance
Sea West Insurance
Secura
Security Co of Hartford
Security National Co of FL
Sedgwick James
Sentinel
Sentry Group
Shelter Co.
Skandia
Spectrum
St. Paul
Standard Fire Company
Standard Guaranty
State Auto
State Farm
State Mutual
State National Ins
Sun Coast
Sun Life
Superior
Sutter
TICO
TIG Countrywide
Titan
Total
Tower
Travelers
Tri-State Consumer
Trinity Universal
Trust Hall
Twentieth Century
Twin City Fire
UGA
Unicare
Uniguard
Union
United American
United Financial
United Fire & Casual
United Security
United States Fideli
Unitrin
Unsure
US Health Advisors
USF&G
USAA
Utah Home and Fire
Utica
Vasa North Atlantic
Vigilant
Viking County Mutual
Viking Co of WI
Wausau Insurance
Wawaunesa
Wellington
West American
West Bend Mutual
West Field
West Plains
Western Mutal
Western National
Western Southern Life
Westfield
William Penn Life
Windsor
Windstar
Wisconsin Mutual
Workmans Auto
WorldWide
Yellow Key
Yosemite
Zurich North America
Other Company (Not Listed)
How long have you been with this company?
--Select--
Less than 1
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10+ years
How much is your current premium?
When does your policy expire?
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
What type of Home are you insuring?
--Select--
1-2 Family
3-4 Family
Over 4 Family
Condo
Apartment
Other
What is the occupancy status of this home?
Primary Residence
Seasonal Residence
Vacation Property
Rental Property
Address to be insured
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
County
What year was the home built?
What type of dogs do you have, if any?
None
Doberman
German Shepherd
Pit Bull
Rottweiler
Other
What is the total square footage of the home?
How many stories (excluding basement) are there?
--Select--
1
1 1/2
2
3
4+
Bi-Level
Tri-Level
How many bedrooms do you have?
--Select--
1
2
3
4
5
6
7
8
9
10+
How many bathrooms do you have?
--Select--
1
1 1/2
2
2 1/2
3
3 1/2
4
4 1/2
5
5 1/2
6
6 1/2
7
7 1/2
8+
Type of Electical System
--Select--
Circuit Breakers
Fuses
Approx age of furnace (in years)?
Approx age of roof (in years)?
What type of heat source do you use?
--Select--
Gas
Electric
Boiler
Oil
Propane
Stove
Other
Unknown
How many fireplaces do you have?
0
1
2
3
4+
How many wood stoves do you have?
0
1
2
3
4+
What type of garage do you have?
--Select--
No Garage
Carport
Attached - 1 car
Attached - 2 cars
Attached - 3 cars
Not Attached - 1 car
Not Attached - 2 cars
Not Attached - 3 cars
Other
How many wooded porches, patios, or decks do you have?
0
1
2
3
4+
How is your dwelling sided?
--Select--
Brick
Stucco
Vinyl
Wood
Stone
Metal
Veneer
Cinder Block
Log Home
Other/Not Sure
What type of roofing do you have?
Asphalt (Most Common)
Colored Granules
Metal
Clay
Wooden Shingle
Flat Roof
Composite Shingle
Other
Describe your foundation or basement
--Select--
Basement less than 50% finished
Basement more than 50% finished
Crawl Space
Open (Cement Non-Solid)
Piers Pilings Stilts
Slab (Cement Solid)
Other
Don't Know
How far away from a fire station is your home?
less than 5 miles
5-10 miles
more than 10 miles
How far away from a fire hydrant is your home?
less than 500 feet
500-1,000 feet
more than 1,000 feet
How much coverage is needed on the dwelling? (in dollars; for example 250,000)
How much coverage is needed on the contents?
(If you do not want contents coverage, enter 0)
Requested amount of liability
$50,000
$100,000
$200,000
$300,000 (Most Common)
$400,000
$500,000
$1,000,000
more than $1 million
Not Sure
Requested Deductible
$100
$250
$500
$1,000
$2,000
$2,500
$5,000
Many companies use credit information for rates and discounts. How would you honestly rate your credit history?
Poor
Fair
Good
Excellent
How many homeowners claims have you filed in the last 5 years?
None
1
2
3
4
5+
Please let the agents you are matched with know how they can get in touch with you. Your contact information is given only to the agents you are matched with. We will never sell, give, or otherwise transfer your personal information to any person or entity other than these agents.
First Name
Last Name
Gender
Male
Female
Check here if your contact address is the same as your property address.
Address
Apartment / Suite
City
State
--Select--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Daytime Phone
Evening Phone
Email
How did you hear about Vargas & Vargas?
Friend
Family Member
Realtor
Banker/Mortgage Broker
Attorney
Other
Best Time to Contact You
Morning
Afternoon
Evening
Best Method to Contact You
Phone
Email
US Postal