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With LeadExchange™ working for you, you'll have confidence that the leads that your web site produces are only from interested consumers.  Below you'll find a sample Homeowners Insurance lead.  All consumers are required to fill out a standardized questionnaire in order to be considered a valid lead.  To return, please click here

What does homeowners insurance cover?

Homeowners insurance provides protection for your home, personal property such as furniture, clothing, appliances as well as for personal liability. It protects you from a variety of events, including fire, lightning, burglary, vandalism, storms, explosions, and more..

Instructions:  Please fill in this form as completely as possible in order to ensure that your quote will be as accurate as possible.

First Name

 

Last Name

 

Street Address

 

City

 

State

 

Zip Code

 

Day Phone

 

Evening Phone

 

E-mail Address

 

Best time to call:

 

Who is this quote for?

 

Gender

 

What month did you buy your home in?

 

Purchase Price (or) Replacement cost of your home:

$

Type of Home

 

Year Built

 

Square Feet

 

Electrical System

 

Type of Construction

 

Do You Have An Alarm?

 

Do You Have Central  Air

 

Number of Fireplaces

 

Number of Bedrooms

 

Number of Bathrooms

 

Do you have a pool?

 

Garage Type

 

Have You Made A Claim  In The Past 5 Years?

 

Your Current Fire/Home  Insurance Carrier: (Leave blank if you have none)

 

Would you like an additional quote for any of the following insurance products?

 Life Insurance
 Annuities (Retirement Vehicle)
 Disability Insurance
 Long Term Care Insurance
 Health Insurance
 Group Health Insurance
 Auto Insurance
 Home Loans

 

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