New Business – Boyster Insurance

Are you an existing or new client? *

First Name *Please enter the full legal name that will be listed on your insurance policy.

Last Name *

Second Insured First NamePlease enter the full legal name that will be listed second on your insurance policy.

Second Insured Last Name

Property Street Address *Please enter the address for which you are obtaining insurance.

Property City *

Property ZIP / Postal Code *

Is this property held in a trust? *

Trust NamePlease enter the full Trust Name that will be listed on your insurance policy.

Phone Number *

Email Address *

What is your occupation? *Generally speaking, what do you do for a living?

What is your marital status? *

Mailing Street Address *

Mailing City *

Mailing State *0 / 2

Mailing Zip Code *0 / 5

Property Usage *Please select how your property will be used.

Are you currently in escrow? *

What Escrow Company are you using?Please enter the name of the Escrow Company you are using to purchase your property.

Estimated Closing Date

Please enter the approximate date your escrow will be closing.

Date Your Current Insurance Policy Expires

Do you have a mortgage on this property?

Will you have a mortgage on this property?

Preferred Deductible *Please select your preferred deductible.

Liability Coverage *Please select your preferred personal liability coverage.

Contents Coverage *Please enter the dollar amount of your preferred contents coverage. This should include the value of all furniture, appliances, and personal belongings at the property.0 / 11

Loss Of Use Coverage *Loss of Use coverage only applies when your home becomes uninhabitable resulting from a covered loss. This coverage covers any Additional Living Expense, meaning any necessary expense that exceeds your normal standard of living.0 / 11

Stories *Please select number of stories.

Year Built *Please enter the year the property was built.0 / 4

Square Footage *Please enter the square footage of your property.

Have you had any homeowner's claims in the last 5 years? *This includes claims at other properties.

Decks *Please select number of decks.

Fireplaces *Please select number of fireplaces.

Claim DetailsPlease provide a brief description of the claim.

Date Of Claim

Bedrooms *Please select the number of bedrooms.

Bathrooms *Please select the number of bathrooms.

Parking *Please select the number of parking description that best applies.

Is the garage attached or detached?

AttachedDetached

Other Structure - DescriptionPlease provide a brief description of the other structure.

Please select all that apply.

Hot Tub/SpaPool (Fenced)Pool (Unfenced)

Dog Breed(s)Please enter the breed of the dog(s).0 / 1000

Year Roof Replaced *Please enter the year the roof was replaced.0 / 4

Year Heating UpdatedPlease enter the year the heating was last updated.0 / 4

Year Electrical UpdatedPlease enter the year the electrical was last updated.0 / 4

Year Plumbing UpdatedPlease enter the year the plumbing was last updated.0 / 4

Roof Type *

Siding Type *

How did you hear about us?

Additional questions or comments.Please enter any additional questions or comments.0 / 180

Is the garage attached or detached?

Other Structures *

Air Conditioning *

Is there an active Company Monitored Burglar Alarm? *

Are there indoor sprinklers for fire supression? *

Is there a spa/pool? *

Any dogs at this property? *

Is there a trampoline at this property? *

Please select all that apply.