Office
102 Main St South
Hutchinson, MN 55350
Phone: 320-587-2674
Toll: 888-234-2910
info@ciahutch.com

Hours
Mon-Thurs: 8:30am–5pm
Fri: 8:30–4pm
Other times by appointment.

Home Owners Insurance Quote

Name:

Address:

City:

State:

Zip:

County:

Email:

Home Phone:

Work Phone:

When can we contact you?

Day Evening

Type of Home:

1 Story 1.5 Story 2 Story

Tri-level Quad Level Other

Type of Construction:

Frame Brick Stucco Other:

Year Built:

Total Square Feet:

Main Floor Square Feet:

Basement:

Finished Unfinished None

Garage:

Unattached Attached None

Holds how many vehicles?

Porch:

yes no Covered Un-covered

Size of Porch:

Deck:

yes no

Type of Deck:

Size of Deck:

Number of Bathrooms:

1 1.5 1.75 2 3

Type of Heat:

Natural Gas Electric L.P. Gas Oil Wood

Heat - Year Updated:

Fireplace:

yes no

Central Air:

yes no

Roof Type:

Roof - Year Updated:

Electrical:

Fuses Circuit Breaker Amps:

Electrical - Year Updated:

Plumbing - Year Updated:

Value of Personal Property:

Miles for Fire Department:

Recreation Vehicles:

Boat Snowmobile 4-Wheelers

Are any businesses or professions conducted on the premises? yes no

If yes, please describe:

Is any business property kept on the premises? yes no

If yes, please describe:

If you have items of special value (jewelry, silverware, guns, antiques, fine arts,
collectibles) that you would like insured, please list here.

Loss History Information

Date	Type of Loss	Amount

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