Insurance Agency, inc.   
330 May Mart Drive
Rochelle, IL  61068
(815) 562-4152













Pay your bill online

Avoid a ticket-Click here for details
 


 Home Insurance Quote
   

*Since our agency's focus is on professional, personable service,  we must limit our customer range to Illinois customers only.

PLEASE NOTE: Required fields are in red.
Fill these fields out to obtain accurate pricing, any indication of rates provided are subject to underwriting, verification of information and acceptance by the Insurance Company. 
   

   
Address Information
Name:   
SSN:
Address:  
City:
State:
Zip:

 

horizontal rule

Daytime/Evening Phone Numbers

Day Time Number:  
Evening Number:
Best Time To Call 
E-mail:

   

horizontal rule


Home Insurance -  Underwriting Information
   

STORIES CONSTRUCTION FOUNDATION ROOF
1-Story 
1 1/2-Story 
2-Story 
Split Level 
Bi-Level		 Frame or Stucco 
Masonry
Masonry&Frame 
Frame&Masonry		 Basement 
Crawl Space 
Slab 
Family Room or Den		 Asphalt Shingle 
Wood Shingle 
Tile or Slate 
Other 
Age of Roof 

   

Policy Type
# of Units
Year Built Square Feet
Year Purchased
Purchase Price
Plumbing Year 
Last Update		 Drains
Electrical System Last Update
Central Alarm
Heating Last Update
Central Air
# of Fireplaces
# of Bathrooms
Garage # of Car Garage
Size of Decks
Swimming Pool
Flood Area
Mine Subsidence
Area

    

Prior Losses Past 5 Years
Bankruptcy Ever Filed

   

horizontal rule

Current Insurance Information
      

Insurance Carrier
Expires
Deductible

 

horizontal rule


Current Insured Values

Dwelling Personal Liability
Personal Property Medical Payments
Personal Injury Scheduled Property
Flood Coverage Other Coverage 
(Business/Hobby/Farm)

   

horizontal rule

Other Coverage or Special Needs
   



   
 

home | contact us | who we are | our aims | our services | our products | our staff |  
our companies  | independent | privacy policy

Copyright 2010, Query Insurance Agency, Inc.