SKORUSA.com Home Owners-Insurance Quote Form
All information is treated with strict confidence.
Your FIRST Name:*
Your LAST Name:*
Living w/ Significant Other
Property Address to be insured:*
Mailing address (if different from Property To Be Insured)
Choose a State
District of Columbia
How many years have you lived at the above insured property address?*
If you have moved in the past 3 years OR purchasing a new location, what was your previous address?
Is home in a trust? (If Yes, indicate if Irrevocable or Revocable and Name of Trust)*
Best Phone Number to reach you:*
Highest Education Level
Choose a Highest Education Level
Law or Medical Degree
Are you a member of AAA?*
Are you a member of AAA?
YES, provide ID# below
AAA ID# (If applicable)
Name of Spouse or Co-Owner:
Spouse or Co-Owner D.O.B.
Current Carrier Information
Who is your CURRENT home owner insurance company?
Insurance Carrier Name:
# of years with current Carrier?*
When does your CURRENT home owner policy renew?
Next Renewal Date:*
Effective Date of New Coverage?*
Approximate Current Annual Premium*
Tell Us About Your Home
Type of Home*
Type of Home
Single Family Residence
3 Story Unit Building
Townhouse End Unit
Townhomr Middle Unit
I`m a Renter
Exterior Walls are made of what? Must = 100% (Ex. 80% veneer brick 20% vinyl siding)*
Furnace Yr Updated*
Plumbing Yr Updated*
Electrical Yr Updated*
Roof Yr Updated*
# of Amps?
Year Home Purchased*
Is the dwelling considered an earth home, geodesic home, dome home, berth home, yurt, or have an open foundation? IE. Pier, stills*
# of Stories*
# of Stories
Choose a Foundation
% of Foundation Type (Must = 100%) Ex. 25% Crawlspace 75% Baement*
1 Car Garage Attached
1 1/2 Car Garage Attached
2 Car Garage Attached
2 1/2 Car Garage Attached
3 Car Garage Attached
4 Car Attached
1 Car Garage Detached
1 1/2 Car Garage Detached
2 Car Garage Detached
2 1/2 Car Garage Detached
3 Car Garage Detached
4 Car Garage Detached1 Car Garage Attached
1 Car Built-In with Rooms Above
1 1/2 Built-In with Rooms Above
2 Car Built-In with Rooms Above
2 1/2 Built-In with Rooms Above
3 Car Built-In with Rooms Above
4 Car Built-In with Rooms Above
1 Car Carport
2 Car Carport
How many FULL Bathrooms*
How many FULL Bathrooms
How many HALF Bathrooms*
How many HALF Bathrooms
Add-Ons? (Select all that Apply)*
Add-Ons? (Select all by Cntrl and Left Click)
Fireplace x 1
Fireplace x 2
Swimming Pool (Inground)
Swimming Pool (Above Ground)
Business In Home
Deck? If YES # of Sq Feet*
Porch? If YES Indicate if Open/Enclosed/Screened & # of Sq Feet*
If Yes, Is it Above Ground or Inground?
Compare $500 vs $1000
Compare $1000 vs $2000
Dwelling Coverage Amount*
Liability Protection Limit*
Liability Protection Limits
Sump/Water Back-Up Limit*
Monitored Burglar Alarm?*
Monitored Burglar Alarm?
Dead Bolt Locks?*
Dead Bolt Locks?
Do you own a DOG?*
Type of Dog(s)
Any Dog BITE CLAIMS the past 5 years?*
Any Scheduled Personal Property?*
Describe any Scheduled Personal Property and Coverage Amounts:
Example: 1 ct yellow gold necklace appraised 2006 for $5000
Current Mortgage Co Name, Address, Loan#*
Insurance premium escrowed?*
Insurance premium escrowed?
Any business conducted in home? (If Yes, what kind of business?)*
Any Home Owner Claims?
Any Home Claims the past 5 Years?*
If Yes, provide details (Date/Type Of Loss/Amount Paid)
Cancelled or NonRenewed in last 5 yrs?*
Cancelled or NonRenewed?
If Yes, provide reason
May we help you in any other way?
Give me an AUTO quote
Quote my Boat, ATV, RV, Motorcycle, or Trailer
Do you want an Umbrella quoted? If Yes, how much coverage?
Term Life Insurance quote
Do you want a quote on Flood Insurance?
How did you hear about us?*
Please provide any additional comments or questions here:
NO COVERAGE OF ANY KIND IS BOUND OR IMPLIED BY SUBMITTING INFORMATION VIA THIS ONLINE FORM
* By submitting this information, you agree that we may use information from you and other sources, such as driving, claims, and insurance score histories, to calculate an accurate price for your insurance.