Home Quick Quote Form DOWNLOAD FORM Name(Required) First Last Spouse's Name First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) HOME PROFILEWhat year was your home built?Construction Type (Ex: brick, frame, etc.)Approximate Square FootageType (ranch, split level, 2 story, etc.)How close is the nearest fire hydrant to your house in feetDo you have a full basement YES NO Is your basement finished YES NO Is there an exterior door from your basement YES NO Do you have central air conditioning YES NO Do you have a wood or gas fireplace YES NO Number of kitchens in your homeNumber of full bathrooms in your homeNumber of half bathrooms in your homeDo you have a garage YES NO Number of spaces in garageType of garage ATTACHED BASEMENT DETACHED Do you have a trampoline YES NO Do you have swimming pool YES NO Breed of dog(s) if you own anyPlease list any home claims in the past 5 years.Please list the date of any updates you have made on your homeRoofFurnace/ACElectricalPlumbingSidingOtherCOVERAGES ( Optional )Your current home coverage value $Your current policy deductible $Your personal property limits $Do you have coal mine subsidence coverage YES NO Do you have sewer drain backup coverage YES NO CAPTCHA**Coverage cannot be bound or altered without confirmation from Summit Insurance.