WBW Insurance Agency, Inc. Bill West, Gurnee WBW Insurance Agency, Inc. Bill West, Gurnee WBW Insurance Agency, Inc. Bill West, Gurnee
Bill West - Illinois and Wisconsin Insurance Agent

Bill West - Wm B West Insurance Agency, Inc.
Illinois & Wisconsin (224) 538-2006
WBW Insurance Agency, Inc. Bill West, Gurnee
Request an Insurance Quote for:

Dwelling Fire Insurance
Contact Information
We can only underwrite businesses and residents located in Illinois and Wisconsin.
 
Name
Street Address
City
State
 Zip
 
Contact Name
Phone
Fax
Email
 
Current Insurance Information   Personal Information
 
Are you currently insured?
Yes   No
If "yes" list the name of the carrier and expiration date:
Please list claims made in details & corrections made:
 
Owner's Birthdate:
Current Home Lender & Loan Amount:
Primary Policy Holder's Credit History:
Describe any past bankruptcies or reposessions, if any::
 
Dwelling Information
 
HOME DESCRIPTION
Year Built:
Square Footage:
Is this home currently being constructed? Yes No
If yes, list month and year for expected completion:
Number of Units:
Single Family Duplex
Type of Construction:
Wood Frame Cement Block
Type of Siding:
Vinyl Aluminum Brick Wood
Type of Roof:
Shingle Wood Shake Tar/Gravel Metal Other
Type of Foundation:
Slab Crawl Basement Other
If Basement, Amount Finished:
None 25% 50% 75% 100%
Number of Stories:
1 1.5 2 3
Occupants:
Owner Occupied Tenant Occupied Seasonal Dwelling Vacant or For Sale
# of Bedrooms:
# of Bathrooms:
Garage or Carport: Yes No
If yes, attached or detached: Attached Detached
If yes, how many cars:
Type of Plumbing:
Copper Galvanized
Mixed Copper & Galvanized PVC
Circuit Breakers or Fuses?
Circuit Breakers Fuses
Type of Heating:
# of Fireplaces:
# of Chimneys:
 
OTHER FEATURES:
Is there a trampoline on the property?
Yes No
Do you own any pets or animals?
Yes No
If yes, list types of animals:
If any dog(s), list breed(s):
Is there a swimming pool?
Yes No
If yes, is it fenced?
Yes No
Describe pool & features (i.e. in-ground, diving board, jacuzzi, etc.):
List any other structures/buildings on premises:
List any other special features (i.e. deck, alarm system, air conditioning, etc.):
Number Feet to Nearest Fire Hydrant:
Number Miles to Nearest Fire Station:
Describe any type of business conducted on premises, if any:
 
Coverage Desired
 
Dwelling Coverage: $
Contents Coverage: $
Liability Coverage: $
Describe any special coverages needed (i.e. jewelry, etc.):
 
Deductible

$500
$1000
$1500
$2000
$2500
 
 
 
The information on these pages is intended to be accurate at the time posted. It is for general informational purposes only. Because of the nature of this information, it may not be applicable in your area or current at the time you read it. Please see your agent or review the policy contract for detailed information you can rely on. The information on this site may change without prior notice.
 
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