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BUCKI HOMEOWNERS INSURANCE QUOTE FORM
To Receive a Homeowners insurance quotation, fill out the form and push the "SEND DATA" button at the bottom of this page.

Send Email to: (your e-mail address)

Your Name (first, last):

 Birth Date (MM/DD/YY):

Address:

City: State: Zip Code:
 
Home Phone #    Home Fax #

CURRENT INSURANCE INFORMATION

Do you have current Homeowners insurance?
     
If so, what is the current Insurance Co's Name?

Policy Number:     Expiration Date:

INFORMATION ABOUT YOUR HOME

What is the current insured value of your home?
 
What amount of deductible do you want?   
Deductible amount is the amount you pay yourself before insurance pays anything. Once you have met the deductible amount, insurance then starts paying their share, depending on the type of insurance you are purchasing. The higher the deductible amount, the lower the insurance premiums.

What liability limit do you want?
The liabilities of home ownership are great. You need protection from claims or suits brought against you for accidental damage to someone else's property or accidental bodily injury to others. With this in mind, you need to determine the amount of liability you need.
 
What is your home's type of construction ?
 
In what year was your home built?
 
Do you have a wood stove in your home?  
 
Do you have fire extinguishers in your home?  
 
Do you have dead-bolt locks on your doors?  
 
Do you have any smokers in your household?  
 
If your home had a fire, which fire department would respond?
 
How far away (in miles) are you from the fire department?

What is the total jewelry value in your home?
If you have jewelry in your home, such as wedding rings, family heirlooms, what is the total value of this jewelry?  If you have this jewelry insured separately, put "yes" for the next question.
 
Is this jewelry currently insured?
 

Would you like a salesman to call with your quote or have it mailed?  
Anything else you would like to tell us?

DON'T FORGET TO PUSH "SEND DATA" BEFORE LEAVING THIS PAGE!

NEED MORE HELP? Call 630-377-2600

HELP YOU CAN COUNT ON
FROM BUCKI INSURANCE


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