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EQ Online Quote Request

EQ Insurance Residential Quote Form

To expedite this request, please complete all necessary information. Quotes will be returned within 24 hours (most of the time, within the same day!)


Producer Name: *
Producer Code: *
Producer Fax: *
Producer Email: *
 Please indicate which way to send your quote
Fax quote  
Email quote
Named Insured: *
2nd Named Insured:
Address: *
City, State *
Zip Code: *
Insured Phone Number: *
Mailing Address, if applicable:
  Geovera
Pacific Select
QBE Insurance
Universal North America
Pacific Specialty Ins.
Please choose the desired deductible options
15% Standard

10% Comprehensive

15% Comprehensive
For QBE/Universal quotes only
QBE/Universal Pool Endorsement (up to $25,000) / Increased Loss of Use (up to 20% of Cov A, Max $100,000)
Does the risk have existing EQ Damage?: *
Is the risk under course of construction?: *
Prior Earthquake Carrier: *
Year Built: *
Living Area: *
Number of Levels: *
Foundation Type: *
Foundation Bolted (Y/N)?: *
Does the dwelling have Cripple Walls? (Y/N): *
If Basement, please indicate sqft area.:
Daylight Basement (Y/N)?:
Is dwelling withing 500ft from the beach (high tide line)? (Y/N): *
Unit Type: *
Number of Units: *
Construction Type: *
Slope (within 50ft of dwelling): *
Garage Type: *
Garage Size: *
Roof Material: *
Primary Heat Source: *
Central Air Conditioning: *
Number of Full Bath: *
Number of Half Bath:
Select the number of bathrooms that have the following items:
 
Corian, Granite, Authentic Marble Counter tops:
Spa or Jaccuzi Tub: *
Double Sink: *
Bathtub and separate shower stall: *
Kitchen Quality (choose all that apply):
Corian, Granite, Authentic Marble Counter top

Commercial Style Refrigerator

More than one oven

6 or more total range top burners

Center island w/ cabinets or sink
Please select up to six (6) siding types. Indicate the percentage of each type of material by entering a value of 0-100 for each item (or leave blank if 0%).
Adobe:
Aluminum:
Brick Solid
Brick Veneer or Brick on Frame:
Log Siding:
Stucco on Frame:
Stucco on Block:
Stone Veneer:
Stone (Solid):
Vinyl:
Wood Shake:
Wood Siding/Plank:
Flooring Type and Percentage (optional):
Wall Covering type and Percentage (Optional):
Number of Masonary Chimney: *
Number of Wooden Chimney: *
Describe any decks or porches (include sqft):
Swimming Pool Characteristics: *
Please check if applicable
Central Fire Alarm
Burglar Alarm
Shape of Building:
Current Fire Ins. Carrier (For QBE/Universal quotes):
Coverage A (for QBE/Universal quotes):
Coverage C (Contents for QBE/Universal Condo quotes):
Remarks:
  I am interested in the EQ Deductible Buyback Program and a quote for my client!
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