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Home Insurance Online Quote

All fields marked with an asterisk (*) are required to complete the form. However, please complete as many fields as possible to ensure that we can prepare your quote as soon as possible.

Please note that Keystone Insurers Group cannot guarantee the security of any information you submit through these forms. If you feel uncomfortable submitting personal information over the Internet, but wish to learn more about our company, products or services, please give us a call at 814-781-7234.


About Yourself

* Name:

* Email Address:

* Address 1:

* Address 2:

* City:

* State:

* Zip Code:

* Phone (Day):

Phone (Evening):

Fax:

* Date of Birth (mm/dd/yyyy):

* Social Security Number

 

Property Information:

Do you currently have home insurance?:

Yes No

If Yes, when does your policy expire? (mm/dd/yyyy):

If Yes, who are you currently insured with?:

If Yes, how much is your home insured for?:

Year purchased (if home):

Purchase price (if home):

Loan amount (if home):

Monthly rent (if rental):

Approximate interior square footage:

Approximate year built:

Is your home located within 1,000 feet of a fire hydrant?:

Yes No

Is your home located within 5 miles of a fire station:

Yes No

Is your home susceptible to flooding or high water?:

Yes No

Is your home built on a hillside?:

Yes No

Is your area prone to landslides and/or sinkholes?:

Yes No

Is your home located within a brush hazard area?:

Yes No

Do you have a dog?:

Yes No

Are there any firearms in your home?:

Yes No

Is there a central alarm system?:

Yes No

Have you experienced any losses or filed any claims within the last 5 years?:

 Yes No

Details

Any comments or question?