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J.J. Palmtag, Inc

Phone
(402) 873-3344
Fax
(402) 873-3506
E-Mail Us
J.J. Palmtag, Inc. (Nebraska City)
1010 Central Avenue
Nebraska City, NE 68410




Home Insurance Quote



Step 1: INSURED GENERAL INFORMATION
Named Insured(s):
Mailing Address:
City, State and Zip:
Phone:
Email:
Date:
How'd you hear about us?


Step 2: DWELLING REPLACEMENT COST ESTIMATOR
(This allows us to estimate a proper amount of protection for your house)
Residence Address if differnet:
Year Built:
Construction Type:
First Floor Sq Footage:
Number of Stories:
Roof Type:
Basement:
Central Air:
Heat Type:
Garage:
Total Baths (count 2 Halfs as 1 Full)
Total Decks:
Total Fireplaces:
Wood Stove:
Other Dwelling Info:


Step 3: DISCOUNTS
(Many companies offer various discounts)
Year of Most Recent Renovation:
Heating:
Plumbing:
Roof (required)
Wiring
Deadbolt Locks, Fire Extinguishers, and Smoke Detectors?
Burglar Alarm?
Age of Oldest Insured Member?


Step 4: CURRENT POLICY INFORMATION
(Enter in your current policy info so we may compare our protection)
Cov A: Dwelling $
Cov B: Other Structures $
Cov C: Personal Property $
Cov D: Loss of Use $
Cov E: Personal Liability
Deductible
Scheduled Personal Property? (high value jewelry, guns, fine arts) If so, list items and value:
Current Company
Premium $
List all losses to incl. the approx date and payout for 3 years:
Addl Current Policy Info:


Step 5: GENERAL UNDERWRITING QUESTIONS
Number of Acres?
Property located in town?
Name of Primary responding Fire Dept?
Miles away from Fire Dept?
Distance to Fire Hydrant? (ft)
Any outbuildings? If so, list buildings, their usage, and value:
Any farm exposures (horses, etc)? If so, please explain:
Addl Info:


Step 6: Click below to Email this form back to us and we will
compare the prices of several different companies for you!


** NOTICE OF ORDERING CONSUMER REPORTS **
JUST SO YOU ARE AWARE OF OUR PROCEDURES, OUR COMPANIES WILL ORDER CREDIT, MOTOR VEHICLE, LOSS INFORMATION AND PRIOR INSURANCE REPORTS. THIS INFORMATION WILL BE USED TO EVALUATE YOUR APPLICATION.
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