Home Insurance Quick Quote Use this form to request a home insurance quote from the Kauffold Agency. Complete the form as accurately and completely as possible to receive our best possible premium. * indicates a required field. Personal Information First Name * M.I. Last Name * Date of Birth * January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Home Address * City * State * Zip * Home Phone Email Address * Occupation Place of Employment Smokers in Household? Yes No   Home Insurance Information   Currently Insured? Yes No Current Insurance Company Policy Expires Insurable Value Year Built Construction pick one Wood frame Brick veneer Masonry Brick Deductible Pick one 100 250 500 1000 Liability Limit Pick one 100,000 300,000 500,000 Describe all claims in the past 3 years including date and amount paid. (Type "NONE" if no claims made).
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