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Home Insurance Quote

Building Information

* INDICATES REQUIRED FIELD

TYPE OF HOME

YEAR BUILT

CONSTRUCTION TYPE

FOUNDATION

ROOF TYPE

ROOF AGE

GARAGE TYPE

SQUARE FOOTAGE

PRIMARY HEATING

BEDROOMS

BATHROOMS

STORIES

FIRE ALARM

IS YOUR HOME LOCATED IN A FLOOD PLAIN?

SECURITY SYSTEM *

MUNICIPAL LOCATION

DO YOU HAVE ANY OF THE FOLLOWING BREEDS OF DOGS: CHOW, DOBERMAN, GERMAN SHEPHERD, PIT BULL, ROTTWEILER, WOLF HYBRID, OR A MIX OF THESE?

Policy Information

APPROXIMATE REPLACEMENT COST OF DWELLING (NOT INCLUDING LAND)

PERSONAL LIABILITY COVERAGE DESIRED

DESIRED DEDUCTIBLE

WHEN WOULD YOU LIKE THIS POLICY TO START?

HAVE YOU REPORTED ANY CLAIMS OR LOSSES TO YOUR INSURANCE COMPANY WITHIN THE PAST 5 YEARS?

WILL THIS INSURANCE REPLACE AN EXISTING POLICY?

CREDIT RATING

Contact Information

First Name

Last Name

Phone Number

ADDITIONAL COMMENTS?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

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We are licensed in Colorado, Arizona, California, Georgia, Illinois, Indiana, Iowa, Kansas, Maryland, Michigan, Missouri, Montana, Nebraska, Nevada, North Carolina, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

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West Way Agency
Diversified Commercial Insurers (Assoc.)
Buffalo Creek, CO 80425
(303) 838-4175
Click Here to Email Us

Buffalo Creek, Colorado.JPG by Jeffrey Beall