RESIDENTIAL INSURANCE QUOTE

To receive a quote online, please fill out the form below
(Montana residents only)
This form will be automatically E-mailed to Bidlake Agency, Inc.; if you are uncomfortable providing any information requested please call us directly at (406) 245-6224 and we will provide you with a quote via phone.

NAME:

STREET ADDRESS: (OPTIONAL)

MAILING ADDRESS: (OPTIONAL)

CITY: , MT. ZIP:

E-MAIL: (REQUIRED FOR E-MAIL QUOTE REPLY

PHONE NUMBER: (OPTIONAL UNLESS PREFERRED METHOD OF REPLY IS BY PHONE)

FAX:

PREFERRED METHOD OF CONTACT: E-MAIL PHONE FAX:

DWELLING LOCATION (CITY ONLY IF DIFFERENT THAN ABOVE):
IS THIS RESIDENCE INSIDE, OR OUTSIDE OF CITY LIMITS? INSIDE OUTSIDE
IF "OUTSIDE" CITY LIMITS, PLEASE TELL US THE RESPONDING FIRE DEPARTMENT AND ONE WAY DISTANCE (IN MILES) FROM YOUR RESIDENCE.

YEAR OF CONSTRUCTION:
TYPE OF CONSTRUCTION:

IF THE TYPE OF CONSTRUCTION IS "OTHER" PLEASE EXPLAIN:

IF THE YEAR OF CONSTRUCTION IS PRIOR TO 1960 WHEN HAS THE FOLLOWING BEEN UPDATED (YEAR):
PLUMBING: HEATING: WIRING: ROOF:
DOES THIS RESIDENCE HAVE SMOKE DETECTORS? YES NO
DOES THIS RESIDENCE HAVE A WOOD STOVE / WOOD STOVE INSERT? YES NO
DOES THIS RESIDENCE HAVE A FIRE EXTINGUISHER? YES NO
DOES THIS RESIDENCE HAVE AN ALARM SYSTEM? YES NO
IF THIS RESIDENCE DOES HAVE AN ALARM SYSTEM IS IT?
IF THE ALARM IS CENTRAL STATION MONITORED PLEASE SPECIFY THE MONITORING COMPANY:
DO YOU NEED FLOOD INSURANCE? YES NO
ANY CLAIMS IN THE LAST THREE (3) YEARS? YES NO

IF THE ANSWER IS YES TO THE ABOVE QUESTION PLEASE LIST APPROXIMATE DATE (MM/DD/YY FORMAT) AND A BRIEF DESCRIPTION OF THE LOSS AND THE AMOUNT PAID.

DO YOU INSURE YOUR VEHICLE (S) AND YOUR HOME WITH THE SAME COMPANY?
YES NO
WHO IS YOUR CURRENT HOME INSURANCE PROVIDER?
PLEASE PROVIDE US WITH YOUR CURRENT COVERAGE LIMITS (IF ANY) FOR A COMPARISON WITH YOUR CURRENT POLICY:
DWELLING: $
OTHER STRUCTURES: $
PERSONAL PROPERTY: $
LOSS OF USE: $
PERSONAL LIABILITY: $
MEDICAL PAYMENTS EACH PERSON: $
DEDUCTIBLES: $
ADDITIONAL COVERAGE'S: $

ADDITIONAL REMARKS OR COMMENTS:

PLEASE TELL US HOW YOU FOUND US:

WE WILL MAKE EVERY EFFORT TO PROVIDE A QUOTE WITHIN THREE (3) BUSINESS DAYS.

QUOTE DISCLOSURE: COMPLETING THIS FORM IN NO WAY BINDS OR PUTS ANY INSURANCE COVERAGE IN FORCE WITH BIDLAKE AGENCY OR ANY OF THE INSURANCE COMPANIES BIDLAKE REPRESENTS.

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