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Allatoona Insurance Agency

Auto - Home - Business - Life - Health - Flood

770-975-9955 Office

770-917-9904 Fax

We Make You Whole Again

Name*

Address*

City*

State*

Zip*

E-Mail Address*

Primary Phone Number*

Alternate Phone Number

DOB*

Visible to Neighbors*

Select an option

Yes

No

Do you have a current homeowners insurance policy*

Select an option

Yes

No

Current Premium

Current Insurance Provider*

Any unresolved Claims

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Yes

No

Current Policy Effective Date*

Expiration Date of current policy.*

Year Home Built*

Roof Type*

Select an option

Asphalt Shingle

Metal Shingle

Tin

Steel

Gable

HIP

Clay

Construction Type*

Select an option

Frame

Masonry

siding

Aluminum

Vinyl

Stucco

Date of original purchase

Number of families living in home*

Number of Bedrooms *

Select an option

2

3

4

5

More

Liability Limit*

Any Business on premises*

How old is the Roof Years old*

How far is a fire hydrant from the insureds home*

How old are your A/C unit updates*

Electrical Wiring updates*

Plumbing updates*

Do you have a Deck*

Yes

No

Do you have a swimming pool*

Select an option

yes

no

Do you have any animals*

Select an option

yes

no

Do you have a fence*

Select an option

Yes

No

Do you live on a farm*

Select an option

yes

no

Are there any out buildings?*

Select an option

yes

no

Any claims in the last 5 years*

Select an option

yes

no

Were there any additions added to your house*

Select an option

yes

no

Do you want flood coverage*

Select an option

yes

no

Do you want Earthquake coverage*

Select an option

Yes

No

Do you have any smoke Detectors*

Select an option

Yes

No

Do you have a fire extinguiser*

Select an option

Yes

No

Do You have a burgler alarm*

Select an option

Yes

No

Do you have a Basement*

Select an option

Yes

No

Garage*

Select an option

1 car

2 car

3 car

More

No

Attached*

Yes

No

SQ Ft of House only*

Sq Ft of Garrage*

Ever had Insurance Canceled*

Select an option

Yes

No

Room over Garage or Attic*

Select an option

Yes

No

Dead Bolt Locks*

Select an option

Yes

No

Do you have a Wood Stove*

Select an option

Yes

No

Do you have a trampline*

Select an option

Yes

No

Do you have a fence around It

Select an option

Yes

No

Do You have a Pool*

Select an option

Yes

No

InGround or Above*

Inground

Above

Fenced

Any Decks*

Yes

No

Attached

Sq Ft of Deck*

Number of Stories*

Select an option

1

2

3

More

Is Under the bottom floor*

Slab

Crawl Space

Open Pier

Number of cars*

Number of Bathrooms*

Number of Bathrooms*

Select an option

Basic

Custom

Semi Custom

Builder Grade

Is outside of house*

Select an option

Brick

Frame

Block

Log

Any Outside Bldgs*

Select an option

Yes

No

Allatoona Insurance

Welcome Home.

You should feel at home with your insurance protection. We're here to help make that happen

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