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Lighthouse Santa Cruz

CREATING PEACE OF MIND
SINCE 1964

Home Insurance New Business

DOB:
Month
Day
Year
Date of Purchase (best estimate):
Month
Day
Year
Primary Home:
Yes
No
If no:
Landlord
Vacant
2nd Home
VRBO/AirBnB
Renewal/Cancellation Date:
Month
Day
Year
Reason for requesting this quote:

We must receive the above requested documents within 48 hours of receiving your home information in order to submit out to our markets.

Garage:
Attached
Detached
Built-In
No Garage
Sprinklers:
Yes
No
Fireplace:
Yes
No
Wood Burning Stove:
Yes
No
Propane Tank:
Yes
No
Alarm:
Yes
No
Roof Type:
Comp/Asphalt Shingle
Tile
Metal
Clay
Wood
If roof is comp/asphalt shingle:
Architectural Shingle
3 Tab Comp Shingle
Luxery Comp Shingle
Pool:
Yes
No
If yes, is pool fenced:
Yes
No
Foundation:
Full Perimeter Foundation with Crawlspace
Concrete Slab
Pier & Beam
Basement
Other

Interior flooring material. (Percentage of total flooring area must equal 100%).

Type of house siding:
Wood
Stucco
Stucco & Wood
Fiber Cement
Brick / Stone
Do you have a dog(s):
Yes
No

*Please note: if you leave this page before hitting submit, your form will not be saved.

Interested in other coverage options or a package discount?

Earthquake Insurance
Flood Insurance
Personal Umbrella Protection
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