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Zip
Phone number
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Desired policy effective date?
Is property currently insured?
Yes
No
What year was your home built?
Sq. ft. of home without finished basement?
Style of home
Ranch
Colonial
Contemporary
Tri-level
Split level
Cape Cod
Town house end
Victorian
Adobe
Mediterranean
Town house center
Row house center
Queen Anne
Row house end
What is your home's primary siding type?
Wood siding
Stucco on frame
Vinyl siding
Brick veneer
Solid brick
Hardy Plank
Aluminium siding
Clapboard Brick & block
Wood shakes
Stucco on block
Logs
Stone veneer
Fire resistive
Poured concrete
Stone & block
Block (painted)
EIFS/Synthetic Stucco
Adobe
Solid stone
What type of foundation is your home on?
Closed Basement
Crawlspace
Walk-In
Slab
Stilts
Is your basement finished?
No
1/4
1/2
3/4
Fully
Garage type
No Garage
1 car - Attached
2 car - Attached
3 car - Attached
1 car - Detached
2 car - Detached
3 car - Detached
Number of stories
One
One + Half
Two
Two + Half
Three
Three + Half
Four
Roofing material
Asphalt shingles
Composition shingles
Concrete tile
Tin/Membrane
Wood shake
Clay tile
Wood shingles
Tar or Gravel
Spanish tile
Slate Foam
Plexiglass
Heating type
Gas hot air
Gas hot water
Electric
Central air
Propane hot air
Propane hot water
Oil hot air
Wood
Wood-Prof
Do you have central air conditioning?
Yes
No
Thank you for contacting us.
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Case & Son Insurance, Inc.
220 East Main Street
Marion, Kansas 66861
Phone
620-382-2106
After Hours
620-382-5903
Fax
620-382-2615
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