Home Insurance Online Quote Request Home Insurance Quote "*" indicates required fields Step 1 of 11 9% This field is hidden when viewing the formSourceName* First Last Phone Number*Date of Birth (mm/dd/yyyy)* MM slash DD slash YYYY Email* Enter Email Confirm Email Address of Property to Insure* Street Address City Postal How many years have you lived at this address?*Select ...< 11234567891011121314151617181920 +Current Address*If this is a new home purchase, what is your current address. Enter SAME AS ABOVE or YOUR CURRENT ADDRESS. Renewal / Start Date*What is the renewal date of your current policy or date you wish coverage to start?” DD slash MM slash YYYY Current Insurance Company*How Long With Current Insurance Company?*How many years have you held continuous home insurance?*Select ...None12345678910 +How many claims have you had on your home insurance in the past five (5) years?*Select ...None12345+ What is the current approx market value of your home?*If you were to sell your home today, what would be the asking price?Do you have a mortgage on your home?*Select ...Yes - 1 mortgageYes - 2 mortgages or moreNoDoes the property have a sump pump?*Select ...YesNoUnsureDoes the home have a Sump pit?*Select ...YesNoUnsureDoes the home have a backflow valve installed?*Select ...YesNoUnsureDoes the home have a monitored alarm?*Select ...YesNoUnsure What is your home type?*Select ...Single-detachedSemi-detachedCondoTownhouse | RowhouseDuplexTriplexFour-plexFive-plexSix-plexOtherPlease specify home type ...*You indicated 'Other' above, please specify.What is your home style?*Select ...BungalowBungalow with Loft2 StoryBi-LevelSplit-Level3 Story4 StoryWhat year was your home built?* How many stories high is your home (excluding basement)*Select ...11.522.534+What is the square footage of your home?*How many bathrooms?*Select ...11.522.533.54 or more What material covers MOST of the exterior of your home?*Select ...BrickMasonryAluminum | Stucco | Vinyl | MetalWoodWhat type of roof do you have?*Select ...WoodAsphalt shingleMetalClayOtherWhat Year was your roof last repaired/installed?* What percentage of your basement is developed?*Select ...No basement100%75%50%25%0%Do you have a garage?*Select ...NoDetachedAttachedBuilt-inBasementCar portWater Heater Type*Select ...Standard TankTanklessAge of Water Tank*Age of Furnace and Last Service Date*Type of Plumbing*Select ...CopperPEXPoly BOther / UnsureAge of Plumbing*Provide age of plumbing in years.Electrical Type & Details*Include: Age of electrical, how many amps and wiring type. Is your property within 300 m (1000 ft) of a fire hydrant?*Select ...NoYesIs your property within 8 km (5 miles) of a fire station?*Select ...NoYesOther FeaturesCheck all that apply Deck Porch Pool How is your home heated?*Select ...Central gasCentral electricCentral oilElectric baseboardHeat pumpHot waterOtherDo you have any additional sources of heating or cooling? (select all that apply) Central air conditioning Fireplace Gas fireplace Fireplace insert Wood or pellet stove Stove using fuel Are you part of a group?*Example: REALTORS® or other profession.Select ...YesNoGroup Name*Please provide the name of your professional group.Do you currently have auto insurance?*Select ...YesNoDo you currently have any schedule items on your current insurance?*Select ...YesNoNot SureDo you have any rental properties?*Select ...YesNoDo you own any other properties?*Select ...YesNoHow did you hear about us?*Select ...GoogleFacebookRadio AdReferred by BrokerReferred by OtherReferred by:*Please provide us the name of the specific Broker or staff member who referred you.Consent*As your broker, we are gathering this consent on behalf of the insurer who advises us that: in respect of this quotation/application, any policy we issue and subsequent renewals or changes, we may collect, use and disclose personal information reports including policy history, claims history, investigative information, rating information, risk information and only with respect to you, your personal credit information including credit score, as permitted by law and in accordance with our privacy policies. Do you, and on behalf of others listed, authorize us to collect, use and disclose to appropriate third parties, including your broker, this information solely relating to your personal property policy for the purposes necessary to assess the risk, determine a premium, determine eligibility and conditions for a premium payment plan, investigate and settle claims, analyze business results and detect and prevent fraud? I agreeCAPTCHA Save big with StoneRidge Group Home & Auto group discounts on home and automobile insurance. CONTACT US