We appreciate your Interest in the many Insurance solutions Manjoe Insurance Offers. To obtaiin a Quote fill out the form below and submit it. A represenative will be in contact with your Quote.

Manjoe Staff

Homeowners Quote Form
Fields marked with asterisks (**) are required.

To fill out this section it will be helpful to understand the terms.

Replacement Cost
The Cost it would take to replace the residence including the garage and any outbuildings. It may also refer to the cost to replace all of the contents that are contained in the residence. This includes all personal effects including clothing, linens, books, furniture, kitchen utensils, lamps, pictures and any other personal property that is contained within the building.
Market Value
The value that the property would sell for on the selling market today. The Market Value varies from the Replacement Cost. The Market Value is not the same as the replacement Cost.
Actual Cash Value
This value is the replacement cost less depreciation on the property. Personal Property can be provided on the Actual Cash Value basis due to the use of the property prior to the loss which has caused the property to decrease in value.

General Information

If you answered yes above please enter Mortgagee Address the Loan Number and Mortgage contact information below.

Financial Information

Please fill out the general information , providing us with the means to deliver the quote. Note: Policy Holder(s) must be those persons named on the Deed as owner of the property.

Mortgage Information

Structure Information

Do you have Personal Property such as Jewelry, Furs, Antiques that you would like to Schedule at specific values?

Scheduled Items
If you have Jewelry, Furs, Antiques, Firearms, Coin Collections, Stamp Collections, Gold, Precious Metals or other items that are valued higher than standard limits and would like coverage specifically provided on those items, you will need to provide an appraisal on the items to secure a quotation for coverage.

Please indicate below the type of items you would like to receive a quotation for.

Business Information

Disclaimers

Mortgage Contact Name:
** Contents Replacement Costs (ex.165000):
Business License Number:
Business License Type:
Fax:
** Building Replacement Costs (ex.165000):
** Miles to the nearest fire company
** Email Address
** Phone:
** Market Value (ex. 120000):
** Year the structure was constructed(ex 1995):
Loan Number:
Mail Address if different from above (include City, State, Zip):
Describe the type of business operated on the property. If the business is a child daycare then please provide max number of children on the property at one time. Also indicate if business is licensed and the license jurisdiction, i.e. State, City, County, etc.
Describe the pets residing on the property.
Describe the fireplaces or woodstoves on the property.
Describe the multiple families residing on the property.
** Policy Holders Full Name(s) (Last Name, First Name MI):
Mortgagee Address(including City,State,Zip)
** Personal Property to be Scheduled at Specific Values
** Property Address (include City ,State, Zip):
Property and Mailing Addresses are the Same
** I agree and grant permission to obtain my personal information from consumer reporting agencies for the purpose of generating an Insurance Homeowners quote.

You must respond to the following items to receive a premium quotation.
** Insurance scores are subject to the Fair Credit Reporting Act. An insurance score is a type of consumer report similar to a credit report. Many insurance companies require favorable insurance score reports to qualify for their Preferred rates.
I have been advised of my rights under the Fair Credit Reporting Act and authorize you to obtain my insurance score.
** Do you have a mortgage on the property that you are requesting a Homeowners quote on ?
Yes
No
** About Pool
There is a In-ground Pool that is fenced or secured when not in use.
There is a Pool (Not In-Ground) that is fenced or secured when not in use.
There is a Pool that is NOT fenced or secured when not in use.
No Pool exists on the property.
** About Spa/Hot Tub's
There is a Spa/Hot tub that is fenced or secured when not in use.
There is a Spa/Hot tub that is NOT fenced or secured when not in use.
No Spa or Hot tub exists on the property.
** Do woodstoves or fireplaces exist on the property?
Yes
No
** Do pet's reside on the property?
Yes
No
** Do Multiple families reside on the property?
Yes
No
** Is a business operated on the property?
Yes
No
** Please Indicate where billing for this account would be sent:
Property Address Above
Mailing Address Above
Mortgagee Address Above
** This information is collected for the purpose of obtaining a premium quote only. No coverage of any kind is bound or provided by submitting information or by receiving a premium quote.
I understand that I should maintain my current insurance coverage and I acknowledge that by receivieving this quote no covered is afforded or bound.
Although I do not have any insurance I do realize and acknowledge that by receiving this premium quote no coverage is afforded or bound.
** About Trampoline
There is a Trampoline that is fenced or secured when not in use.
There is a Trampoline that is NOT fenced or secured when not in use.
No Trampoline exists on the property.
** Construction Style:
** Construction Type:
** Indicate when Siding updates occured:
** Indicate when Heating/Cooling updates occured:
** Indicate when Electrical updates occured:
** Provide Homeowner Insurance Quote By:
** Sprinkler System Installed?
** Indicate when Roof updates occured:
** Alarm System Installed and Type?
** Indicate when Plumbing updates occured:
** Distance to nearest Fire Hydrant:
** Electrical Type:
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