Riverbend Insurance Corporation
405 W Walnut Suite 1 Newport, WA 99156
509-447-0426 kevin@riverbendins.com
dba: Kevin Wright Insurance Agency in State of CA
RIVERBEND INSURANCE
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Needed Home Quote Info:
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How did you hear about us?
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Phone Book
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Roxy Onscreen Ad
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Name
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First
Last
Spouse
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First
Last
Date of Birth
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SSN
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SSN is not required, but is very helpful in providing the most accurate quote.
Date of Birth
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SSN
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SSN is not required, but is very helpful in providing the most accurate quote.
Address
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Line 1
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City
State
Zip Code
Country
Phone Number
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Email
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Year Built
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Sq Feet all floors
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Basement?
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Yes
No
Crawl Space
Daylight
Walk out
Floors
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1 Story
1.5 Story
2 Story
Type
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Frame
Machined Log
Hand Hewn Log
Masonry
Singlewide Mobile
Doublewide Mobile
Triblewide Mobile
Majority Flooring
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Hardwood / Laminate
Carpet
Vinyl
# Baths
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1
1.5
2
2.5
3
3.5
4
Heat Source
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Electric
Gas
Oil
Wood Stove/ Fireplace
Select One
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Deck
Porch
None
Sq Feet
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Covered?
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Yes
No
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Deck
Porch
None
Sq Feet
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Covered?
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Yes
No
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Deck
Porch
None
Sq Feet
*
Covered?
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Yes
No
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Garage
Shop
Barn
Storage Shed
None
Sq Feet
*
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Attached to house
Detached
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*
Garage
Shop
Barn
Storage Shed
None
Sq Feet
*
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Attached to house
Detached
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*
Garage
Shop
Barn
Storage Shed
None
Sq Feet
*
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*
Attached to house
Detached
# of Acres
*
Choose One
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Pool
Trampoline
Hot Tub
# Pets / Animals
*
Type and Breed
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Flood Coverage?
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Yes
Not Desired
Home Owner Assoc.
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Yes
No
Earthquake Coverage?
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Yes
Not Desired
Current Ins. Company
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Approx Annual Premium
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Non Renewed?
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Yes
No
Describe and Claims in the past 5 years
*
Other Information or comments
*
Photos are very helpful: email us photos at
rates@riverbendins.com
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