209-354-4164 📩Email Us

Homeowner's Insurance
Appointment Request

📣 IMPORTANT: To schedule an appointment, you must complete the form below.

Once submitted, you’ll be redirected to our calendar to reserve your appointment time. Appointments booked through this form receive top priority in our agency. This ensures we have all the details needed in advance to make the most of our time together.

📌 IMPORTANT: Please read this section before completing the form.

First, thank you for the opportunity to help with your homeowner’s insurance. We understand that many Californians are facing policy cancellations, reduced options, and sharply rising premiums. You're not alone — and we're navigating these challenges too, right alongside you.

Due to ongoing restrictions and carrier limitations, there are only a small number of insurers actively writing homeowner’s policies. These remaining carriers require detailed documentation, higher premiums, and longer review times — which is why this form is detailed and why every field is required.

We also require a copy of your current insurance documents before we begin. This step is non-negotiable, as most carriers won’t allow us to quote without it.

If you need insurance the same day or within two weeks, we may not be the right fit. Our quoting process is thorough and designed to deliver quality, not speed.

Estimated turnaround times:

– Standard quote: within 72 business hours after your phone appointment

– CA FAIR Plan indication: 72 hours

– CA FAIR Plan formal quote: up to 15 days

We appreciate your time and look forward to helping you through this process. If you're ready to move forward, please complete the form below and schedule 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.

Additional Information

Let us know if there's any additional details that you think we should know in order to help you.

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