Home Insurance [inc. Condo and Rentals]

Home or Condo Insurance In Arizona & California

Thank you for considering Sheltra Insurance Group, LLC for an Online quote submission. Please provide as much information as available within the application, below, for the most accurate quote(s).

Upon completion of this information, hit "submit" once and the form will be sent to a representative for quoting. The information provided will then be quoted among the multiple insurance carriers our office proudly represents.

A representative will respond with the quote(s) via the contact option selected, below, normally within 1 business day.

*If you have any difficulty with this application or prefer to speak with an associate directly, please call us at: 928-317-1212.

Home Insurance — Yuma, AZ — Sheltra Insurance

For your convenience, you may also submit a copy of your existing insurance policy, below, by utilizing this Submit Document button.

Submit Document

Applicant Information

APPLICANT INFORMATION

Full Name

Date of Birth

Marital Status

Property Address

City

Property State

Zip Code

Mailing address, if different

Co-Applicant Information

CO-APPLICANT INFORMATION

Full Name

Date of Birth

Relation to Insured

Contact Information

CONTACT INFORMATION

Cell Phone #

Home Phone #

Work Phone #

E-mail

Preferred method of contact

Cell Phone

Daytime/Home

Work

E-mail

Property Information

PROPERTY INFORMATION

Type of Dwelling/Home

Occupancy [How will the Home be used?]

Requested effective date

Year the Home/Condo was purchased?

Is this for a Home Closing?

Purchase Price (USD)

Does the Purchase Price include the land?

*Requested amount of Homeowners Insurance?

Program type: Replacement Cost or Actual Cash Value

Year the Home/Condo was built?

# of Stories

# of Bedrooms

# of Bathrooms

Square Footage of home?

Type of Construction

Type of Foundation

Type of Siding Materials

Type of Heating/Cooling source

Fireplace or Woodstove?

Home Alarm?

Type of Roofing Materials

Roof Shape

Age of Roof

Type of Flooring [Ex. 25 % Carpet/75% Tile]

Special Features? [Ex. Solar Panels, Skylights, Upgrades, etc]

Is there a Swimming Pool or Spa?

*If yes, is the pool completely fenced with a self-locking gate?

Other Information

OTHER INFORMATION

Prior Insurance Information

*If yes, with what company?

Do you have an attached Garage or Carport?

Other unattached structures? [Shed]

Description of other unattached structures: Ex. length and width, construction type, year built, etc.

Do you have any dogs on the property?

*What type/breed of dog and how many?

During the time you have owned the home, have there been any losses and/or claims on the home in the past 5 years?

*Yes: Please enter Claim information in next box

*If yes, please give information on what type of loss/claim, such as wind or water, and apx. when the loss occurred and how much was paid out on the claim

Financial Information

FINANCIAL INFORMATION

Ownership/Title Status

Paid from Escrow?

Mortgagee Loan #

Lienholder/Mortgagee Name

Lienholder/Mortgagee Address

Lienholder/Mortgagee Address 2

*Lienholder/Mortgagee City

*Lienholder/Mortgagee State

*Zip Code

Additional Comments/Questions/Items to Note

I authorize the Sheltra Insurance Group to verify my credit and/or insurance history.

Phone: (928) 317-1212 | Address: 670 E. 32nd St. Suite 12, Yuma, AZ 85365 | Email: Sheltrainsurance@yahoo.com

Phone: (928) 317-1212

Address: 670 E. 32nd St. #12 Yuma, AZ 85365

Email: Sheltrainsurance@yahoo.com