Full Name:          
Address to be Insured:
City:
State:  Washington or Idaho
Zip Code:
Email Address: (Required) 
Home Phone:   Work Phone:   Ext.
How to Contact You:       Cell Phone:
Date of Birth:              (mm/dd/yyyy)
Social Security #:       

Spouse Name:             
Date of Birth:              (mm/dd/yyyy)
Social Security #:       

Do you currently have Washington Flood Insurance?
Do you currently have WA Homeowners Insurance?
Coverage requested for?
Usage Type:
Years Lived at Address to be Insured:  

Washington Homeowners Insurance Coverages & Limits of Liability:

Dwelling ($ value):
Additional Structures ($ value):
Personal Property ($ value):    

Personal Liability (each occurence):
Medical Payments (each person):   
Other Perils Deductible:
Windstorm Deductible:

Policy Endorsements:

Replacement Cost, Dwelling: Yes No
Replacement Cost, Contents: Yes No

Washington Homeowners Insurance - Dwelling Information:

Building Structure:
Year Dwelling Built:     Dwelling Square Feet:
Smoke Detectors?             Deadbolt Locks?    
Central Burglar Alarm?      Central Fire Alarm?
Sprinklered All Rooms?
Primary Heat Type:
Do you have a Wood Stove? If yes, is it on a separate flue?

Fireplace: 
Full Baths:     Half Baths:   
Garage:         Garage Size:
Basement:

Type of Wiring:         
Wiring Renovation:         Wiring Renovation Year:   
Plumbing Renovation:     Plumbing Renovation Year:
Heating Renovation:       Heating Renovation Year:  
Roofing Renovation:       Roofing Renovation Year:  
Roof Type:     Roof Age (years):
Exterior Paint Renovation:     Exterior Paint Renovation Year:

Dwelling Distance from Fire Department:  miles
Dwelling Occupied By:
Swimming Pool:              Diving Board:  
Pool Screened:               Approved Fence:  

Loss History:

Did you have any losses, whether or not paid by insurance, during
the last 3 years, at this dwelling location or any other location?
If the answer to the previous question was "Yes", please explain below.

Date                            Type            Description of Loss           Loss Amount
      
      
      

Additional Information or Comments



Click on the "Submit Quote Request" button below to send
your Washington Homeowners Insurance quote request.**


**Information received from this Washington Homeowners Insurance quote request
form sent to The Fletcher Agency will be for our use only and will not be sold,
given to or distributed to any other parties. A quote will be based on the Washington
homeowners insurance policy information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to
meeting underwriting guidelines, and the terms, conditions and exclusions of
the policy as issued. By submitting this request you acknowledge that this is
neither an offer to insure nor a guarantee of insurance. Completion of this form
does not entitle you to a Washington Homeowners Insurance policy. We are
licensed in Washington and Idaho, and will not provide homeowners quotes for
other states.


Washington
Homeowners
Insurance Quote
The Fletcher Agency of
Spokane, WA offers
affordable and
experienced personal
insurance coverage
services throughout
Washington.
Contact us about
Washington Auto,
Renters, Homeowners,
Boat, Motorcycle,
Earthquake, Flood, and
Condominium Insurance
at (509) 324-6311.

In addition to
Washington Home
Owner Insurance
quotes, we also offer
other affordable
Washongton Insurance
policy quotes.
We are a Spokane, WA insurance agency offering affordable
Washington homeowners insurance quotes in the following towns,
cities and counties in Washington state: Opportunity, Millwood,
Dishman, Seven Mile, Veradale, Spokane Valley, Trentwood,
Pasadena Park, Glenrose, Country Homes, Greenacres, Newman
Lake, Otis Orchards, Airway Heights, Mead, Colbert, Buckeye,
Chattaroy, Milan, Deer Park, Elk, Clayton, Tumtum, Long Lake,
Ford, Deep Creek, Reardan, Four Lakes, Medical Lake, Espanola,
Marshall, Tyler, Cheney, Vallyford, Spangle, Plaza, Mica, Freeman,
Manito, Fairfield, Waverly, Rockford, Whitman County, Pend
Oreille County, Lincoln County, Stevens County, and Spokane
County, WA. We can also offer lower cost Washington
homeowners insurance policy quotes throughout the state of
Washington.

Applicant Information
We can provide cheaper Washington Homeowners Insurance
coverages in Spokane County, WA and throughout the Evergreen State!
The Fletcher Agency
421 W. Hastings Road
Spokane, Washington 99218
Spokane County, WA
Office: (509) 324-6311
Fax: (509) 324-6340

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