Homeowners Quote Form


Please take a minute to fill out the quote form.  Once completed this form will be sent to our office for review and quoting.  Thank you for quote!

Butler & Associates collects information from consumer reporting agencies such as claims information and insurance scores to use in providing you with a quote.

Personal Information
First Name
Required
Last Name
Required
Date of Birth
Required
Spouse or Co-Owner
Optional
Spouse or Co-Owner Date of Birth
Optional
Street Address
Required
City
Required
State
Required
select
ZIP / Postal Code
Required
Phone Number
Required
E-Mail Address
Required
Dwelling Information
Dwelling address if different from above.
Optional
Occupancy
Required
select
Year Built
Required
Construction
Required
select
Exterior of Dwelling
Optional

Hold down the Ctrl Key to make multiple selections.
Square Feet (above ground)
Required
Style of Home
Required
select
Garage
Required
select
Roof Type
Required
select
Kitchen
Required
select
Number of Full Baths
Required
select
Number of 3/4 Baths
Required
select
Number of 1/2 Baths
Required
select
Percent of Flooring Material By Type
Hardwood
Optional
Laminate Wood
Optional
Ceramic Tile
Optional
Carpet
Optional
Vinyl
Optional
Percent of Wall Coverings By Type
Paint
Optional
Wallpaper
Optional
Ceramic Tile
Optional
Wood Paneling
Optional
Basement
Required
Basement Finished
Required
select
Deck
Required
select
Deck Square Footage
Optional
Any Attached Structures
Optional
Heating Type
Required
select
Central Air Conditioning
Required
Pets
Required
select
History of Biting
Required
select
Business conducted on premisis?
Required
Central Fire Alarm
Required
Central Security Alarm
Required
Trampoline
Required
Swimming Pool
Required
Deadbolts all Entry Doors
Required
Fire Extinguisher
Required
Fireplace
Required
select
Homeowners Claims in the Past 5 Years
Required
Year of Last Update
Furnance
Optional
Electrical
Optional
Roof
Optional
Plumbing
Optional
Optional Coverages
Loss Assessment
Required
Sewer Backup / Sump Pump Coverage
Required
Increased Dwelling Coverage
Required
Secondary or Seasonal Dwelling?
Required
Is this a Hobby Farm?
Required
Do You Have?
Jewely valued in excess of $1500?
Required
Firearms valued in excess of $2,500
Required
Silverware valued in excess of $2.500
Required
Furs valued in excess of $1,500
Required
Collections
Required
Antiques
Required
Fine Arts
Required
Property used in business
Required
Personal Property Stored Off Premises?
Required
Domestic Help
Optional
Vacant Land
Required
Recreational Vehicles
Boats
Required
Motorcycle
Required
Snowmobile
Required
ATV
Required
Motorhome / RV / Camper / Popup
Required
Any Structures at your primary address that are not attached to the residence?
Required
List additional structures.
Optional
Current Insurance Information
Current Insurance Company
Optional
Dwelling (Coverage A)
Optional
Additional Structures (Coverage B)
Optional
Personal Property (Coverage C)
Optional
Loss of Use (Coverage D)
Optional
Liability/Medical (Coverage E/F)
Optional
Current Deductible
Optional
Current Premium
Optional
Mortgage Information
Optional
Anything Else you would like us to Know?
Optional
How did you hear about Butler & Associates Insurance?
Required
select
Other Insurance you would like us to quote?
Optional

Hold down the Ctrl Key to make multiple selections.
By submitting this quote request you authorize Butler & Associates to collect consumer reporting information.
Enter Validation Code
Required
CAPTCHA
Change the CAPTCHA codeSpeak the CAPTCHA code
 

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.



Insurance Websites Designed and Hosted by Insurance Website Builder