Huang Insurance: Home Quote
Questions marked by * are required.
1.	Name *
2.	Email *
3.	Phone
4.	Address
5.	City/State/Zip
6.	Date of Birth
7.	Current Insurance Company
8.	Claims in last 3 years None 1 2 3 or more
9.	Type of policy you need Homeowner Renter Condo Owner Landlord
10.	Year Home Built
11.	Number of square feet
12.	Home style 1 story 2 story Tri or Split Level Other- explain below
13.	Garage or Carport None 1-car garage 2-car garage 3-car garage Detached garage Other- explain below
14.	Number of FULL bathrooms 1 2 3 or more
15.	Number of 1/2 or 3/4 bathrooms 1 2 3 or more
16.	Type of roof Flat Asphalt Shingle Tile Wood Shingles Other-explain below
17.	Exterior Wall Frame Stucco Brick Wood Siding Aluminum Siding Other-explain below
18.	Fireplace Yes No
19.	Deck Yes No
20.	Patio Yes No
21.	Deadbolts on all doors Yes No
22.	Smoke alarms Yes No
23.	Fire Extinguisher Yes No
24.	Monitored Security System Yes No
25.	Contents Coverage Amount (if known)
26.	Additional Comments