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Your Home
Coverage
Almost done! What's your contact info?
First name
Last name
Email
Phone
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Date of birth
Gender
Male
Female
Non-binary
Married?
Yes
No
Credit rating
Fair
Good
Excellent
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What kind of home is it
Single Family Home
Appartment
Condo-Townhouse
Duplex
What is the property address?
Address
City
Address1
Address2
State
Postal Code
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Year built
( OK to estimate )
Is this your primary residence?
Yes
No
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Tell us about your current coverage
Is this a new purchase?
Yes
No
Have you had insurance within the last 30 days?
Yes
No
Have you made any home insurance claims in the past 3 years?
Yes
No
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