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Customer Service On-Line Select a Different Form Automobile Quote Homeowners Quote Watercraft Quote Life Insurance Quote Other Quote Automobile Change Homeowners Change Other Change Auto Claim Report Home Claim Report Other Claims Auto ID Cards Certificates Billing Inquiry Back to Service Center menu Homeowners Quote Request Requested Effective Date: Your Name: Your Mailing Address: Street City, State, Zip      E-mail Address: Daytime Phone #: Best way to contact me: Please have a licensed agent contact me to gather the required information. I am completing the information requested below, please have a friendly licensed agent contact me. Current coverage: Company:                          Expiration Date:   Homeowner's Date of Birth: Type of policy desired: Homeowners Insurance Condominium Insurance Renters Insurance   Amount of insurance desired: Homeowners only: What is the value of your home? Condo/Renters only: What is the value of your personal property? Liability Limit: $100,000 $300,000 $500,000 Medical Payments: $1000 $5000 Valuation of Home: Actual Cash Value Replacement Cost Personal Property Valuation: Actual Cash Value Replacement Cost Deductible: $250 $500 $1000 Property Information: What is the construction type of your home? Frame Masonry In what year was your home built? In what County/Township are you located? Distance to the nearest fire hydrant? Less than 500 ft. Over 500, under 1000 ft. Over 1000 ft, under 3 miles Over 3 miles What kind of pets do you have? Do you have a swimming pool? Yes No Do you have a trampoline? Yes No Do you use a wood burner? Yes No Smoke Detector(s) Installed Home Security System Installed   Home Updates:  Enter year updates were made. If year not known, enter "unknown": Roof: Wiring: Plumbing: Heating: Optional Property Coverages: Earthquake Coverage Requested Flood Coverage Requested Sewer/Water Backup Coverage Requested Property Floaters - Indicate limits below: Antiques: Furs: Coins: Jewelry: Computers: Stamps: Fine Arts: Tools: Other Floater Coverage:   Limit of Insurance:   Previous Loss Information Please describe any losses or claims filed on your Homeowners Insurance in the last 3 years: Be sure to include the date of loss, type of loss and the amount of the claim. Additional Comments Please use the box below to enter any additional information you wish to include: Protecting your privacy and identity is very important to us.  Your Social Security number and Drivers License number may be required to complete this quote.  We will contact you personally for this information.          If you have not received a response from us within one business day, please contact us again. Thank you.

Babbitt-Sholund Insurance  201 E. Bell Street, Neenah, WI  54956  •  Phone: (920) 722-7531  Toll Free: (800) 236-8600 Copyright© Babbitt-Sholund Insurance, 2010 Home |  Products |  Companies |  FAQs |  Contact |  Service Center |  Claims |  Payment Options |  Our Privacy Policy