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KS: 913.451.9246

MO: 816.525.9246

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Home Insurance Quote Request

Please fill in your details below. To provide information by phone,
you can call us at 816-525-9246.

If you prefer a PDF questionnaire, click here to download and email to service@myaiminsurance.com. Thank you!

First Name

Last Name

Date of Birth

Single or Married?

Single Married Other

Occupation

Second Insured (spouse or other adult household member)

First Name

Last Name

Date of Birth

Single or Married?

Single Married Other

Email

Phone Number

Is it ok if we text you? (Only to discuss your quote - We won't send spam texts!)

Yes No

How did you hear about us? If referred by someone, please list their name so we can thank them!

Address (current address or new address if purchasing a new home)

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Prior Address (if at current less than 2 years)

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Who is your current home insurance company? If you are buying a new home, please type "new purchase" or "first time home buyer".

How long have you been with them? Skip this question if this is a new home purchase.

How much is your home insurance per year? Skip this question if this is a new home purchase.

When does your home policy expire? Skip this question if this is a new home purchase.

Declarations Section

Please enter your current coverage information from your "Declarations Pages". You can skip this section and email your pages to service@myaiminsurance.com. Alternatively, you can upload your document below.

Declarations Pages

Dwelling (Coverage A) Amount *Enter purchase price if new home purchase

Other Structures (Coverage B) Amount

Person Property (Coverage C) Amount

Loss of Use (Coverage D) Amount

Liability (Coverage E) Amount

Medical Payments (Coverage F) Amount

Deductible Amount

Wind/Hail Deductible Amount

Water Backup Limit

Any other coverages (jewelry rider, earthquake, other endorsements)?

Do you have any dogs?

Yes No

If yes to the above:

How many and what breed(s)?

Have your dogs ever bitten?

Do you have a pool?

Yes No

If yes to the above:

Is there a fence with a locking gate around the pool (not the yard)?

Is it above ground or in-ground?

Is there a diving board or slide?

Do you have a trampoline?

Yes No

If yes to the above:

Does it have a safety net around it?

Is your yard fenced with a locking gate?

Do you operate any kind of business out of your home? If yes, please provide a short description.

Do you have a mortgage?

Yes No

How do you pay your home insurance?

Billed to mortgage company (escrowed) Billed to me monthly Billed to me in full

Is the home in the name of a trust or LLC?

If yes, how should the trust or LLC read?

Year your home was built

Square footage (not including the basement, we'll ask about this later)

Date you purchased your home

Home updates (these help with discounts so please answer accurately)

Roof - Year Updated

Roof - Full or Partial

Full Partial

Furnace - Year Updated

Furnace - Full or Partial

Full Partial

Air Conditioner - Year Updated

Air Conditioner - Full or Partial

Full Partial

Plumbing - Year Updated

Plumbing - Full or Partial

Full Partial

Electrical - Year Updated

Electrical - Full or Partial

Full Partial

Style of Home

Roofing Material

Siding Material (include percentages if more than one type)

Number of Garage Spaces

Garage Type

Attached (no living space above) Built-in (lliving space above) Detached Carport

Foundation Type

Percentage of Basement Finished

Do you have a sump pump?

How many bathrooms do you have?

Do you have a fireplace? If so, how many and what type?

Heat Type

Do you have a deck? If so, what size and material? Is it covered or screened in?

Do you have a porch? If so, what size and material? Is it covered or screened in?

We are licensed in Missouri, Kansas, Colorado and Indiana. We specialize in Home, Auto, Renters, Motorcycle and Boat Insurance.

Get In Touch

Email: service@myaiminsurance.com
Phone: 913.451.9246 | 816.525.9246

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