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Home Insurance Quote

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)?*

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Contact

Stump Insurance

19910 Fisher Ave
Poolesville, Maryland 20837

Mailing Address:
P.O. Box 19
Poolesville, Maryland 20837

Phone: (301) 428-8052

Toll Free: (800) 277-8052

Fax: (301) 349-5466

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

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Stump Insurance Provides Auto / Car Insurance, Home Insurance, and Business / Commercial Insurance to All of Maryland, Delaware, North Carolina, Pennsylvania, Texas, Virginia, Washington D.C., and West Virginia, Including Poolesville, Frederick, and Rockville.

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