209-354-4164 📩Email Us

Homeowner's Insurance
Appointment Request

****ALERT!! - To schedule an appointment with our office you must complete the form below and after you click Submit you will be taken to a page to schedule the appointment. This puts you right on our calendar and is a sure way to reserve an appointment in our agency. Scheduled appointments always have top priority.****

IMPORTANT NOTICE! DO NOT COMPLETE THIS FORM WITHOUT READING THIS FIRST.

First we'd like to thank you for the opportunity to help you with insurance for your home. We know that many homeowners are being nonrenewed by their current insurance company and we know that many Californians are facing an extreme increase in insurance rates. We want you to know that we understand what you are facing and we as insurance agents are facing it right along with you.

Due to the restrictions put in place by the insurance companies there are a limited amount of insurance companies willing to insure homes and the few remaining are requiring a lot of documentation and have lengthy wait times for approval as well as high premiums and because of these things we do require that you complete all of the fields on this form. You WILL have to send us your current insurance documents because can not work without these so please don't ask us to make exceptions on this, this is non-negotiable.

Currently, Underwriters are backlogged and the wait times are lengthy so if you need insurance same day or within a 2 week period we will not be the right agent for you.

TURN AROUND TIME FOR A NEW QUOTE AFTER INITIAL PHONE APPOINTMENT IS 72 HOURS. IF CA FAIR PLAN IS REQUIRED, THE TURN AROUND TIME IS 72 HOURS FOR AN INDICATION AND 15 DAYS FOR FORMAL QUOTE.

Please fil out the information below and reserve your appointment with our office today.

First name*

Last name*

Date of birth*

MM/DD/YYYY

Spouse First Name*

If None type None in the box

Spouse Last Name*

If None, type None into the box

Spouse's Date of Birth*

If no spouse, enter your own birthdate - MM/DD/YYYY

Month/Day/Year

Email*

Phone number*

Does KS Pacific Insurance Have Your Permission to Send You SMS Text Messages*

Data Fees May Apply With Your Cellular Service Provider

Street address*

City*

State/Region*

Zip Code*

Is this a New Purchase*

Who Will Be Living In The Home*

If someone will be occupying the residence within 30 days do not select Vacant

Purchase Date*

Month/Day/Year

Do you have an inspection report?*

What kind of roof do you have?*

Tile, Composition, Metal, Shake etc

What year was your roof replaced?*

yyyy - If unknown enter year the home was built

Has The Heating/AC Been Updated?*

Heating/AC Update Year*

yyyy - If year of update is unknown enter the year the home was built

Electrical Updates*

Electrical Updates Year*

yyyy - If year of update is unknown enter the year the home was built

Plumbing Updates*

Plumbing Updates Year*

yyyy - If year of update is unknown enter the year the home was built

Year Built*

Square Foot of Home*

Do you have dogs?

Dog Breed*

If you have other kinds of pets please indicate in the notes section below.

What Kind of Security System Do You Have?*

Must be able to provide security system certificate to receive discount.

What Kind of Fire Alarm Do You Have?*

Have you had any claims in the last 5 years *

Please include any claims related to renters insurance and homeowners insurance

Please list & explain any prior claims from the last 5 years*

List the date and a brief explanation of each claim. If there are none, enter none.

We require that all clients send us a copy of their current insurance documents before we begin working. If you would rather text them then please send them to 209-354-4164 Otherwise use the Choose File button and upload your documents. If you do not have insurance or are a first time home buyer you can disregard this section.

Please Upload Your Current Insurance Documents

After you click Submit you will be taken to a page to schedule an appointment so that you can talk directly to us. This puts you right on our calendar and is a sure way to reserve an appointment in our agency. Scheduled appointments always have top priority.

209-354-4164 📩Email Us

Homeowner's Insurance Appointment Request

Homeowner's Insurance
Appointment Request