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Homeowner Quote Form

Complete our form and we’ll be in touch with your insurance quote.

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Step 1Fill out the form.
Step 2Review your options with us.
Step 3Get the coverage you need.

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Preferred Method(s) of Communication? (Check All That Apply)*

Call

Text

Other

Other:

Would You Like To Receive Updates or Questions Via Text During The Quoting Process?

Yes! Please text me during the quoting process

No. Please do not send me any text communication

Other:

How did you hear about us?

Google

Social Media

Networking Event

Referred by a current or previous client

Other:

If you were referred by an individual, please provide their name below as it will help us route you to the proper agent!

Applicant Information

Please complete this information to the best of your ability. An agent will contact you at the information provided below.

Full Name

First Name Last Name

Date of Birth?

Month

Day

Year

Phone Number*

Email*

Current Occupation*

Secondary Insured (Spouse, etc)

Full Name

First Name Last Name

Date of Birth?

Month

Day

Year

Social Security Number (Can obtain over the phone if desired)

Phone Number*

Email*

Mortgagee/Loan Information

Complete only if you have a lender or mortgagee that you want listed on the policy. If you do not have this information at this time, we can obtain later in the process.

Name of Loan Provider

Mailing Address

Street Address Address Line 2 City State ZIP Code

Loan Number

Will Your Insurance Be Escrowed (i.e. included in your mortgage payment)?

Yes

Unknown

Other:

Address & Purchasing Information

Please complete this section to the best of your ability. Additional information could possibly be needed during the quoting process.

Address

Street Address Address Line 2 City State ZIP Code

Type of Residence?

Single Family

Multi-Unit

Townhome

Other

Other:

New Purchase?

Yes

If Yes, Closing Date?

If No, Purchase Year?

Purchase Price?

Potential Discounts

The following are discounts that may be available depending on the carrier quoted. Please select any discounts that apply at time of quoting. Selecting the potential discount in this quote form does not guarantee it will qualify.

Truck Gross Vehicle Weight?

Full pay discount

Multi-policy discount (if you have an auto or umbrella with Ingram Insurance)

Alarm (central station monitored fire or burglar alarm system)

Qualifying Information

Please complete this section to the best of your ability. Additional information could possibly be needed during the quoting process.

Will There Be Any Dogs At This Location?

Yes

If Yes, What Is The Breed?

Is There A Pool?

Yes

Is There A Trampoline?

Yes

Roofing Information

Please complete this section to the best of your ability. Additional information could possibly be needed during the quoting process.

Truck Gross Vehicle Weight?

Asphalt

Metal

Slate

Unknown

Other:

Year Last Updated?

Plumbing Information

Please complete this section to the best of your ability. Additional information could possibly be needed during the quoting process.

Plumbing Type? (Check all that apply)

Copper

Copper/PVC

Galvanized

Pex

Unkown

Year Last Updated, If Known?

Electrical Information

Please complete this section to the best of your ability. Additional information could possibly be needed during the quoting process.

Electrical Type? (Check all that apply)

200 Amp w/breakers

100 Amp w/breakers

100 Amp w/fuses

60 Amp w/fuses

Knob & Tube

Aluminum

Unknown

Other:

Year Last Updated, If Known?

Section Break

Will This Vehicle Be Utilized As Personal Use Outside of Normal Business Operations?

Yes

Other:

Heating Information

Please complete this section to the best of your ability. Additional information could possibly be needed during the quoting process.

Heating Type (Check all that apply)

Natural Gas

Propane

Fuel Oil

Electric

Geo-Thermal

Unknown

Other:

Year Last Updated, If Known?

Other Structures (Detached Buildings)

Only complete if you want the structure insured along with the main structure.

Description of Structure (Garage, shed, etc)

Type of Structure (frame, brick, etc)

Size

Coverage Limit Requesting?

File Upload

Max. file size: 300 MB.

The Independent Agency Advantage

We are insurance advisors.

We want you to make an informed decision on your insurance coverage. Through education, we work to simplify the process so you can make an informed decision based on your needs.

We offer a wide variety of insurance solutions.

Your insurance needs are unique, your insurance coverage should be too. We help you find insurance solutions by offering a wide variety of coverage options.

We are by your side every step of the way.

You’re never on your own when it comes to your insurance. We’re here for you and work with the insurance company on your behalf.

See All the Reasons

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Our Team Has Your Back

We specialize in a variety of coverage options to meet your unique insurance needs.

Meet Our Team

Prefer to speak with someone from Ingram Insurance Group?
Contact us directly.

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733 Salem Avenue
Dayton, OH 45406

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Building Confidence Through Coverage

Our mission at Ingram Insurance Group is to deliver insurance solutions that meet the needs of our clients, providing a professional and reliable service experience. We are dedicated to supporting our clients’ goals and protecting their valued assets.

We are licensed in Ohio, Kentucky, West Virginia, Tennessee, Pennsylvania, Michigan, and Florida.

Serving Dayton and the surrounding communities across Montgomery County, and proudly headquartered in Dayton, Ohio.

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