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Danielle M. Ellis: Customer Relations

5949 Sissonville Drive Charleston, WV 25312

Phone: 304-984-3004 Fax: 304-984-2101 Email: danielle@insurewithellis.com Text: 304-552-3004


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What type of home do you have?
If Mobile Home, is it a double wide or a single wide?
If mobile home, does it have metal skirting or cinder block foundation?
Is your home frame or brick/masonry (at least 2/3)?
Is this your first home purchase?
How long have you had your current insurance?
Do you currently have coverage for any specific scheduled personal property (ex. guns, jewelry, furs)?
How far is your house from the responding fire department and what is the name of that fire department?
What is your social security number?
Are you married?
Spouse SSN
Have you or your spouse filed for bankruptcy in the last 5 years?
What is your home's physical address?
What is your mailing address? (if different from above)
List approximate dates and details of the incident(s) or put N/A if none
What are all the types of heat you use?
You may select more than one.
What is the primary source of heat?
Do you have any pets?
Has your pet ever bitten anyone?
Do you have a swimming pool?
Do You have a swimming pool?
Is pool fenced?
Is there a diving board
What type of plumbing? (ex. copper, PVC, rubber, galvanized)
You may chose more than one.
What limit of liability insurance are you requesting?
(at least 300k recommended)
How would you prefer to be contacted?
We will send your quote back to you very soon! Thank you for allowing us the opportunity to serve you.  We value our customers and promise to take care of you!