Name: Stump Insurance
Address: 19910 Fisher Ave, Poolesville, MD, 20837, US
Telephone: (301) 428-8052

Owner 1 Name*
First Middle Initial Last
Date of Birth for Owner 1*
Sex Owner 1:*
Marital Status Owner 1:*
Driver License State and Number for Owner 1*
Occupation & Highest Level of Education Owner 1:*
Owner 2 Name*
First Middle Initial Last
Date of Birth for Owner 2*
Sex Owner 2:*
Marital Status Owner 2:*
Driver License State and Number for Owner 2*
Occupation & Highest Level of Education Owner 2:*
Residence Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Residency*
Is this also the Mailing Address?*
- Yes
- No
Prior Address if New Purchase or lived here less than 3 years:
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
House Details
Year Built*
Above Grade Square Footage:*
Number of Bedrooms*
Number of Baths*
Pool?*
- Yes
- No
If yes to pool, please provide the following details: Is pool fenced with a locking gate? Does pool have a diving board? Does pool have a slide?
Is the yard Fenced?*
- Yes
- No
Age of Roof*
Roof Type*
Roof Style: (ex. gable, hip, flat, mansard, A-frame, gambrel, etc.)
Garage (# of Cars - Enter 0 if no Garage...)*
Flooring Types – Please list all flooring types (tile/carpet/laminate/etc.)*
Percentage of each flooring type (Example 70% Tile, 30% Carpet)*
Have there been updates to your Electrical and Plumbing Systems? If yes, please describe.*
Age of Heating System:*
Age of Air Conditioning System:*
Age of Hot Water Heater*
Do you have any secondary heat sources, i.e. a wood burning stove or a fireplace insert?*
- Yes
- No
If yes, please provide manufacturer name and confirm that the stove/insert is UL approved
Do you have an outdoor trampoline?*
Does home have a basement?*
If yes, please provide square footage, describe whether basement is below ground or walkout, and please provide percentage of basement that is finished.
Does home have a deck, screened porch, regular porch, or patio?*
If yes, please describe and provide approximate square footage:
Any Custom Features in the home? If yes, please describe.
Does Home Have (check all that apply):
- Centrally Monitored Burglar Alarm
- Centrally Monitored Fire Alarm
- Interior Sprinkler System
- Water Sensors Tied to Alarm System
- Battery or Water Pressure Back-Up System on Sump Pump
- Smart Thermostats
- A local alarm system such as Ring Cameras?
Do you have any pets? If yes, please provide type, breed, and confirm friendliness/no biting history.*
If yes, please provide type, breed, and confirm friendliness/no biting history.
Do you have children under the age of 18 in the household? If yes, how many?*
Which insurance company currently provides your homeowner coverage?*
Have you had any claims in the past 5 years? If yes, please describe.*
What is your current Dwelling Coverage Limit, Coverage A?*
What is your current Deductible?*
What is your current Liability Coverage Limit (Coverage E)?*
If you would like an Erie Life Insurance price indication, please provide the following:
Name Height Weight
Nicotine Use
- Yes
- No
For a more accurate quote, please complete the Life Quote Form on our website from the Insurance Services dropdown list.
Phone
This field is for validation purposes and should be left unchanged.

Home Insurance Quote

House Details