Earthquake Coverage Quote Request | Standard Lines Services

Agency Information

Agency Name:*

Agency Contact*

Agency Phone:*

Agency Contact Email:*

Insured's Name*

First Last

Insured's Date of Birth*

Insured's Phone*

Insured's Email*

Gender*

What is Coverage A limit on Homeowners or Dwelling Policy?*

Coverages B/C/D are optional and can be selected in an a la carte fashion for the states of MO, AR, and TN

Personal Property

Other Structures

Loss Of Use

Who is current homeowner's carrier?*

Property Address*

(The address of the property requesting earthquake coverage on)

Street Address Address Line 2 City State ZIP Code

Enter Property's County*

Is the mailing address different from property being insured?*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Year of Construction*

How many stories?*

What is the square footage of the house?*

What is the construction type?*

Other construction type

What is the foundation type?*

Any prior earthquake damage?*

Description of prior earthquake damage*

Any outstanding claims?*

Description of outstanding claims*

Any additional comments?

Upload any documents or photos you feel are pertinent to this coverage request

Drop files here or