of Sussex, Wisconsin
262.246.6868 jimstein@associnscenter.com
(licensed in Wisconsin, Illinois, Michigan & Minnesota)
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Home Insurance
Your house is one of the biggest investments of a lifetime - protect that investment with the proper insurance designed for your specific needs. In the case of any unforeseen disaster, make sure that you can recover your investment in as short a time as possible. Don't delay - let us help you evaluate the value of your home and it's contents to make sure that your coverage is adequate.
Contact information
Please complete the follow information so we can contact you with the information you requested.
First Name Last Name Middle Date of Birth mm/dd/yy
Address City State Zip
Phone Best time to call: E-Mail

About your Home
Fill in as much or as little as you please, we will call to better understand your needs
Current insurance expires    or Check here if you Currently Have No Insurance
How much insurance do you have on your home ("dwelling") ? $
Deductible ?
What kind of siding is on it ?
When was your house built ?
If remodeled, what year (give details) ?
How far are you from the fire department that services your area ?
How far is the house from a fire hydrant ?

What is the Comprehensive Personal Liability limit ?

Brief Description of your Need and/or Concerns:

 

 

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