Home Insurance – JJ Insurance Agency

On-Line Homeowners Insurance Quote Form

Complete our Minnesota home insurance information form and we will be in touch soon.

Personal Information

Enter your full name:

Mailing Address:

City:

County:

State:

Zip Code:

Email:

Email (again for accuracy):

Phone:

Dwelling Information

Year home built:

Square footage (foundation size):

Is this builder's risk (new home construction)?YesNo

Month/Year home to be complete:

No. of units:

Type Foundation:

Type Construction:

Type Roof:

Year Updated:

Number of stories:

Do you own animal or pets (if yes, list type/for dogs, list breed)?

Do you own trampoline?YesNo

Do you own woodstove?

No. of feet to nearest fire hydrant:

No. of miles to nearest fire station:

Currently Insured? (If yes, list carrier, and # of years continuous. If none, type NONE):

Name of carrier & how long insured:

Prior Claims?

Describe claims in detail:

Rate your credit history:

(Some companies products are based on your credit and payment history.)

Primary Policyholder's Birth Date:

(Some companies products offer discounts for certain age groups.)

Plumbing Type:

Year Updated:

Heating Type:

Year Updated:

Circuit Breaker or Fuses:

Year Updated:

No. of bedrooms:

No. of bathrooms:

No. of fireplace:

No. of chimneys:

Special features (i.e. deck, air conditioning, alarm systems, pool, etc.):

Home Coverages:

Dwelling Coverage: $

Content: $

Liability Coverage: $

Deductible ($500, $1,000, $2,500, etc.):

Comments/Remarks (describe any scheduled jewelry, guns, furs & collectibles, in-home business, boats, ATV, snowmobile, or other special coverages/remarks here)

Send my insurance quotation via :EmailFaxRegular MailCall me by phone

Thank you for filling out this form completely.We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I agree. Please send me a home insurance quote now.