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Loomis Insurance Services
8175 Limonite Ave. Suite B
Riverside, CA 92509

Office: 951-685-7478
Fax: 951-685-0665
Email Us


Loomis Insurance Services
8175 Limonite Ave. Suite B
Riverside, CA 92509

Office: 951-685-7478
Fax: 951-685-0665
Email Us


Personal Information:


Your Full Name:                                                     Date Of Birth:   
Spouse Full Name:                                                 Date Of Birth:
 
Street Address:   
City:                                     State:                    Zip:   

Phone number:                                        Best time to reach you?     

Email address to send information:   

Do you own your own home, or do you rent?   

Is this a condominium or townhouse unit:
  
Year of construction of home:                                  Total square feet: 
 
Style of home:                               Type of garage: 
 
Is the garage attached or detached from your home?     
Is there built-in living space above the garage?     
Is this a normal tract home, or is it custom built?
   
How many full baths?                         How many half baths?             

How many fireplaces?  

Roof type (I.e. wood shake, etc.):                     Exterior of home (I.e. stucco,): 
 
Is there a burglar alarm?      
Is there a separate Jacuzzi / hot tub?    
Wet bar?                                    Are there fire sprinklers in the attic?   
Is this a new home purchase?   
If yes, escrow close date:   

Name of current insurance carrier:   
Renewal date:   
Number of losses the past three years:   
Amount paid if known:   

Non-smoker?                                                 Are you over the age of 50?     
Any special riders, increased coverage limits on certain items, i.e. jewelry, fine arts etc.





 
Are you interested in earthquake, flood and various options available?    

Do you have an Umbrella liability policy? 

Auto Carrier?

Personal Information:


Your Full Name:                                                     Date Of Birth:   
Spouse Full Name:                                                 Date Of Birth:
 
Street Address:   
City:                                     State:                    Zip:   

Phone number:                                        Best time to reach you?     

Email address to send information:   

Do you own your own home, or do you rent?   

Is this a condominium or townhouse unit:
  
Year of construction of home:                                  Total square feet: 
 
Style of home:                               Type of garage: 
 
Is the garage attached or detached from your home?     
Is there built-in living space above the garage?     
Is this a normal tract home, or is it custom built?
   
How many full baths?                         How many half baths?             

How many fireplaces?  

Roof type (I.e. wood shake, etc.):                     Exterior of home (I.e. stucco,): 
 
Is there a burglar alarm?      
Is there a separate Jacuzzi / hot tub?    
Wet bar?                                    Are there fire sprinklers in the attic?   
Is this a new home purchase?   
If yes, escrow close date:   

Name of current insurance carrier:   
Renewal date:   
Number of losses the past three years:   
Amount paid if known:   

Non-smoker?                                                 Are you over the age of 50?     
Any special riders, increased coverage limits on certain items, i.e. jewelry, fine arts etc.





 
Are you interested in earthquake, flood and various options available?    

Do you have an Umbrella liability policy? 

Auto Carrier?

Request a Homeowners Quote!
License# 0586791
Quotes
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Own Rent 
Yes No 
Attached Detached
Yes No
Tract Custom
Yes No
Yes No
Yes No
Partial Full
YesNo
Smoker Non-Smoker
Yes No
Yes No
Yes No