Auto Insurance, Home Insurance, Life Insurance and more from Barthold Insurance

Homeowners, Rental & Condo Insurance Quote Form

First Name: Last Name: Email Address:
Home Phone: Work Phone: Alternate Phone:
Property Street Address: City: Ca Zip:
Policy Type Type of Residence Year Built Square Feet of Living Area
Number of Stories Garage Type: Size of Garage - # of Cars:
Occupancy: Policy Deductible: Roof Type: Age of Roof?
Number of Full Bathrooms Number of 1/2 Bathrooms
Fireplace? Swimming Pool/Spa/Hot Tub: Yes No
Floor Finish: Hardwood Tile Linoleum Carpet # of Large Skylights: # of Small Skylights:
Has The Dwelling Been Updated: Yes No Description of Update/Work done:
Any Animals?: Yes No How Many: Type/Breed:
Losses in the past 3 years: (Date of loss, loss type, and amount of loss)
Earthquake Coverage: Yes No
What Insurance Company Do You Currently Have: