Keizer Oregon Insurance - Jeff Strike's Insurance Agency

Home Insurance Quote

Homeowners Insurance Quote Form

Personal Information

Name:
Address:
Suite/Apt. Number:
City:
County:
State:
Zip Code:
E-Mail Address:
Home Phone:
Best Time To Call:
Work Phone:
Best Time To Call:
Fax Number:
Current Insurance Company:
Expiration Date:

How would you like to be contacted?

Email Phone Fax

Home Information

Home Location

Physical Address of Home:
City:
County:
State:
Zip Code:
Inside City Limits or Outside:

Rating Data

Total Square Footage of Home:
Year Home was Built:
Construction of Home:
Roof Construction:
Number of Bedrooms:
Number of Bathrooms:

Value

Estimated amount to TOTALLY replace the home.
(The amount of insurance needed for the home)

Insurance Information

Claims

Any claims on this home within the past 3 years?

If yes, please enter date of loss, amount of loss, and cause of loss.

Deductible

Please Choose a deductible amount:

Comments & Helpful Info.

Any comments you feel may be necessary in providing you with this quote:

Thank you for completing our online quote form. Press the "Submit" button, and your inquiry will be sent. We will respond with a quote within two business days.

Jeff Strike Insurance Agency

4959 River Road North
Keizer, Oregon 97303

Phone: (503) 463-5707 | Fax: (503) 463-5708

Electronic Mail:
Direct Email or Contact Form