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Individual's Information
First Name:
Last Name:
Birth Date:
Phone:
Occupation:
Address:
City:
State:
Zip:
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Auto Information
Year:
Make:
Model:
VIN #:
Doors:
2
4
Wheel Drive:
2
4
Style:
Sedan
Wagon
Coupe
Truck
Van
Physical Address of the Moto
Physical Address:
City:
State:
Zip:
Stedman Insurance Agency |
118 American Street,
Sitka, Alaska |
(907) 747-8618
Individual's Information
First Name:
Last Name:
Birth Date:
Phone:
Occupation:
Address:
City:
State:
Zip:
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Boat Information
Year:
Make:
Model:
Class
Length:
Hull Material:
Max Speed:
Value:
Motor Information
Year:
Make:
Horsepower:
Value:
Trailer Information
Year:
Make:
Value:
Physical Address of the Moto
Physical Address:
City:
State:
Zip:
Stedman Insurance Agency |
118 American Street,
Sitka, Alaska |
(907) 747-8618
Individual's Information
First Name:
Last Name:
Birth Date:
Phone:
Occupation:
Address:
City:
State:
Zip:
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Home Owners Quote
Are you the original owner?
No
Yes
Year Built:
Dwelling Value (not including land):
Foundation type
Cement Slab
Crawlspace
Number of Stories:
Total Living Area:
Basement:
No
Yes
% Finished:
Built in or Attached Garage (Number of Cars):
Carport (No. of Cars):
How many full baths?
3/4 Baths:
1
2
3
4
5
1/2 Baths:
1
2
3
4
5
Heat Source?
No. of Fireplaces:
1
2
3
4
5
Single/Multiple Family Home?
single
multiple
How Many Decks?
Porch square footage?
Square footage?
Roof Material?
Siding Material?
Does the house have a Cathedral Ceiling?
No
Yes
How much in percent?
Renovations?
Year Completed?
Deadbolt on all exterior doors?
No
Yes
Smoke Detector?
No
Yes
Fire Extinguishers?
No
Yes
How far from closest fire department?(miles)
How far from fire hydrant? (feet)
Physical Address of the Moto
Physical Address:
City:
State:
Zip:
Stedman Insurance Agency |
118 American Street,
Sitka, Alaska |
(907) 747-8618
Life Quote
Individual's Information
First Name:
Last Name:
Birth Date:
Phone:
Occupation:
Address:
City:
State:
Zip:
+
Add Another Person
Physical Address of the Moto
Physical Address:
City:
State:
Zip:
Stedman Insurance Agency |
118 American Street,
Sitka, Alaska |
(907) 747-8618
Motorbike Quote Form
Year
Make
Model
VIN #
Individual's Information
First Name:
Last Name:
Birth Date:
Phone:
Occupation:
Address:
City:
State:
Zip:
+
Add Another Person
Physical Address of the Moto
Physical Address:
City:
State:
Zip:
Stedman Insurance Agency |
118 American Street,
Sitka, Alaska |
(907) 747-8618
Renters Insurance Quote Form
Apartment Building Size
Family House Size
Room Count:
Bedrooms
Kitchen
Dining Room
Living Room
Dinette/Breakfast nook
Family/Rec Room
Den/Study/Office
Smoke Detector?
No
Yes
Fire Extinguisher?
No
Yes
Deadbolt on all hinged exterior doors?
No
Yes
Do you own window Hangings?
No
Yes
Personal Property Coverage Limit?
Individual's Information
First Name:
Last Name:
Birth Date:
Phone:
Occupation:
Address:
City:
State:
Zip:
+
Add Another Person
Physical Address of the Moto
Physical Address:
City:
State:
Zip:
Stedman Insurance Agency |
118 American Street,
Sitka, Alaska |
(907) 747-8618
