Van Gundy Insurance - Home Insurance Quote

Home Insurance Quote

Please complete the requested information below. When you press submit your information will be transferred directly to a Van Gundy Insurance agent who can assist you. You will be contacted within 1-2 business days to request additional information so an accurate quote can be provided.

Completing this online form enables us to speed up the process of providing a quote. If you have any questions please contact us at (309) 452-1156.

PART A - Personal Information

Full Name:
E-mail:
Address:
City:
State:
Zip Code:
Day Phone #:
Evening Phone #:
Birthday: (dd/mm/yyyy)

PART B - Current Insurance Information

Insurance Company Name:
Policy Expiration Date:
Premium payment term: (annual, semi, quarterly, monthly)
Value dwelling insured for:
Liability amount:
Medical payments:
Deductible:
Any additional coverage (earthquake, water/sewer, jewelry, umbrella):
Number of claims in the last three years:

PART C - Home Information

Year home was built:
How long at current address:
Total Square Footage (excluding garage and basement):
Basement?	Yes No
If yes, total square footage?
Number of stories:
Construction (ie, Frame, Brick):
Garage? (Yes/No, attached, detached, 1,2,3,4)
# of Full Bathrooms:
# of Half Bathrooms:
Fireplace?	Yes No
Deck/porch/patio (square footage)
Security system?

Comments:

Van Gundy Insurance • 101 South Towanda Avenue • Normal, Illinois 61761 • Phone: (309) 452-1156