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Home Insurance Quote

Personal Information

First name:*

Last name:*

Current Address:

City:

State:

Zip code:

Telephone:

Email:*

Occupation:

Home Information

Year Built:

Type:

Stories:

Construction:

Foundation:

Age of Electric: (years)

Age of Plumbing: (years)

Age of Heating: (years)

Basic Interior Features

Living Space (square feet):

# of Full Baths:

# of Half Baths:

# of Chimneys:

# of Hearths:

Additional Interior Features

Finished basement

Central air conditioning

Security system

Basic Exterior Features

Garage Type:

Garage Size:

Roof Type:

Roof Age:

Additional Exterior Features:

Deck

Screened-in porch

Outdoor pool (not fenced)

Outdoor pool (fenced)

Additional Information

I have a dog

I need additional jewelry coverage

I need additional fur coverage

I have a stamp or coin collection

I have firearms I want covered

I have antiques I want covered

I want additional computer coverage

Optional Coverages

Appliance breakdown	Earthquake
Flood	Identity theft

Claims Information

How Many Claims Have You Had In The Past 5 Years?

Type Of Claims:

Earthquake	Explosion	Fire	Flood
Hail	Liability	Lightning	Medical Payments
Smoke	Theft	Vandalism	Water
Wildfire	Wind	Other	All Other

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Wholesale Resources Insurance Solutions
1431 W. Woodcrest Ave
Fullerton, CA 92833
Phone: (714) 947-0201
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