VA insurance quotes from Hayes Insurance

Low cost VA insurance quotes from Hayes Insurance Services, Inc
VA insurance quotes from Hayes Insurance Services, Inc
Virginia insurance quotes from Hayes Insurance Services, Inc
Virginia insurance quotes from Hayes Insurance Services, Inc

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Virginia insurance quotes from Hayes Insurance Services, Inc Virginia insurance quotes from Hayes Insurance Services, Inc
 
Vacant Dwelling Fire
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address to be insured:
City:
State: (Must be Virginia)
Zip/Postal:
E-Mail:
E-Mail (again for accuracy):
Phone:
Fax (optional):
 
Social Security # of Primary Policyholder
(or Federal Tax ID if business/corp.) (required for quotes and all applicable discounting! Your information is completely private & secure)
 
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Is this Builder's Risk?
(new home constr.)
NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
3 family 4 family
 
Home Renovation cost:
 
If Vacant, describe WHY vacant,
how long it has been vacant,
and when it will be occupied again:
 
Type foundation: Basement
Slab
Crawlspace over slab
Other (list in remarks)
(If basement, what % is finished?)
% FINISHED
 
Type Construction: Frame
Brick/Veneer
Stone
Other (list in remarks)
 
Type Roof: Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Does Home Have a Garage? Yes No
Tell whether built in, detached/attached, and how many cars?
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Call Me by Phone

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Hayes Insurance

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Hayes Insurance Services, Inc  |  16003 Woods Edge Road  |  S. Chesterfield, VA 23834  | Office Map Driving Directions
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