Hayes 4 Insurance.com - Virginia vacant home insurance for VA residents and businesses, Low Cost VA vacant dwelling insurance quote.

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Vacant Dwelling Fire Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal Data:

Your Name:
Property Address to be insured:
City:
State: (Must be Virginia)
Zip/Postal:
E-Mail:
E-Mail (again for accuracy):
Phone:
Fax (optional):

Social Security # of Primary Policyholder (or Federal Tax ID if business/corp.) (required for quotes and all applicable discounting! Your information is completely private & secure)


Dwelling Information

Year Home Built:
Home Square footage:

Is this Builder's Risk? (new home constr.)	NO YES

Month/Year home to be complete:

Number of units:	1 family Duplex 3 family 4 family

Home Renovation cost:

If Vacant, describe WHY vacant, how long it has been vacant, and when it will be occupied again:

Type foundation:	Basement Slab Crawlspace over slab Other (list in remarks) (If basement, what % is finished?) % FINISHED

Type Construction:	Frame Brick/Veneer Stone Other (list in remarks)

Type Roof:	Shingle Wood Shake Tar/Gravel Spanish Tile Metal Other

Number of stories:	One 1.5 Two Three

Do you own animals or pets?	Yes No
If yes, list type/for dogs, list breed:

# of feet to nearest fire hydrant:	# of miles to nearest fire station:

Does Home Have a Garage?	Yes No
Tell whether built in, detached/attached, and how many cars?

Currently Insured?	Yes No
Name of Carrier & how long insured?

Prior Claims?	Yes No
Describe claims in detail:

Plumbing type:	Copper Galvanized Mixed (Copper/Galvanized)

Circuit Breakers or fuses?	Breakers Fuses

# Bedrooms: # Bathrooms:

# Fireplaces: # Chimneys:

Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)

Coverages:

Dwelling Cov. $ Contents $

Liability Cov. $ Deductible $
($500, $1,000, etc.)

Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):

Send my quotation via: E-Mail Fax
Call Me by Phone

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