Homeowners & Umbrella Personal Information Name* Current address Phone number* Email* Occupation Current home insurance I currently have a home insurance policy Insurance company Coverage amount Renewal date # of claims in last five years Home information Same as my current address Year built Type —Please choose an option—Basic TractCustomStandardUpgraded / Remodeled Stories —Please choose an option—1.5-story (split)1-story2-story Construction —Please choose an option—Frame or StuccoMasonryMasonry Veneer Foundation —Please choose an option—BasementCrawl SpaceSlab Age of electric Age of plumbing Age of heating Basic interior features Living space square feet # of full baths # of half baths # of chimneys # of hearths Additional interior features Finished basementCentral air conditioningSecurity system Basic exterior features Garage Type —Please choose an option—AttachedBasementBuilt-inCarportDetached Garage Size —Please choose an option—Four-carSingle-carThree-carTwo-car Roof Type —Please choose an option—Asphalt ShingleOtherTile or SlateWood Shingle Roof Age Additional exterior features DeckScreened-in porchOutdoor pool Additional information I'd like my jewelry to be coveredI have a dog Umbrella Coverage Coverage information Requested Coverage $ Number of drivers under 25 years old Assets Personal vehicles that you own, excluding antiques Business vehicles that your company provides you Antique vehicles Boats Personal watercraft Motorcycles Off-road vehicles Properties that you occupy Rental units that you own Comments Olathe, Kansas Office 14812 W 117th St Olathe, KS 66062 Phone: 913-782-1404 Fax: 913-583-5046 Email: [email protected] Hours: 8:30 AM - 5:00 PM M-F Contact Us Type of Insurance: —Please choose an option—PersonalBusinessDental Practice By providing your phone number, you agreed to receive text messages from Goodman Gravley Insurance Source. Message & data rates may apply. Message frequency varies. Reply STOP to opt out. Reply HELP for help. We will not share your opt-in to an SMS campaign with any third-party for purposes unrelated to providing you with the services of that campaign. We may share your personal data, including your SMS opt-in or consent status, with third-party that help us provide our messaging services, including, but not limited to platform providers, phone, companies, and any other vendors who assist us in the delivery of the text messages.
