D'Arcy Insurance Agency, LLC - Homeowners Insurance : Quote Request

Disclosures

D’Arcy Insurance Agency – California Insurance Agency License #0M18632, Michigan Insurance License #0117113, Nevada Insurance License #908572 South Dakota License #10021014

Life Insurance and annuities are issued by selected carriers of D’Arcy Insurance Agency, LLC. Before investing, consider the funds' investment objectives, risks, charges, and expenses and request a prospectus or summary prospectus containing this and other information. Read it carefully.

D’Arcy Insurance Agency, LLC., is a separate and legal entity apart from D’Arcy Wealth Management, Inc. (www.darcywealthmanagement.com) Member FINRA, which provides wealth management and investment products. Investing involves risk, including the potential for loss.

Neither D’Arcy Insurance Agency, LLC., nor its insurance agents, insurance brokers, insurance advisors, financial consultants or employees, provide tax or legal advice. As with all matters of a tax or legal nature, you should consult with your tax or legal counsel for advice.

This material is intended for educational purposes only. D’Arcy Insurance Agency, LLC, through our Insurance Agency offers property and casualty insurance, life insurance. health insurance, disability insurance, and specialty insurance.

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Certain products, such as variable annuities, variable universal life insurance, and mutual funds are available only through securities licensed representatives and sales material must be accompanied by a prospectus. Auto and homeowners insurance and other property and casualty insurance products are available from our network of multi-line agencies. Life insurance and fixed annuity products are available from our network of multi-line agencies.


» Name:
Address:
City:
State:
Zip:
» Home Phone:
Work Phone:
» Email:
Age:

Insurance Type:	Single Family Townhouse Condo Renters
If multi-family bldg, how many residential units:	1-4 5-12 12+
Construction Type:	Frame Masonry Masonry Veneer
Year Built:
Nearest Fire Hydrant:	under 1000 feet none
Nearest Fire Department:	1 2 3 4 5 5+ miles
Smoke Detector:	Yes No
Deadbolt Locks:	Yes No
Fire Extinguisher:	Yes No
Central Station Fire Alarm:	Yes No
Central Station Burglar Alarm	Yes No
Swimming Pool:	Yes No
If yes, is it fenced in:	Yes No
Wood Burning Stove:	Yes No
Do you have a dog:	Yes No
Market Value $:
Existing dwelling coverage amount $:
Desired Coverage Amount $:
Liability Limit $:
Deductible:	250 500 1000
Any special coverages:
Current Insurance Company:
Expiration date (or settlement if new purchase):
Any claims past 5 years:
Please use the space below to add comments regarding any special circumstances.

Homeowners Insurance

Please use the space below to add comments regarding any special circumstances.