Mendoza Insurance
1108 Sheridan Avenue · Chico, CA · 95926 Ph. 530-895-1086 · Fx. 530-894-6166 License #0625161
Office Hours: Mon - Fri · 9am - 5pm · (Closed Noon to 1pm)
Your Name DOB
Email Address Marital Status
Street Address SSN
City, State, Zip ,   
Phone Number   
Provide us with the following information for your customized quote:
Expiration date of your current policy: --
Current Insurance Company:
 
Street address of property to be insured:
City:
ST:
Zip Code:
 
First time home buyer?
Yes No
If no, how long at this address?
Mortgage amount:
 
Have you reported any property
claims within the past 3 years?
Yes No
If yes, please give claim details:
Does anyone in the home smoke?
Yes No
 
 
Tell us about your home
Number of Units:   Building Type:   Garage:
 
Roof Type:   Age Of Roof:
 
Year Built:   Square Feet:
 
Saftey Features
Yes No Is the home equipped with at least one working smoke alarm?
Yes No Does your home have at least one fire extinguisher 2.5lbs or larger?
Yes No Do all exterior doors have deadbolt locks?
Yes No Is there a central station monitored burglar alarm system?
 
Exterior Walls
Enter percent of each as it applies to your home (total must equal 100%).
Stucco On Frame
Stucco On Masonry
Paint On Masonry
Wood Siding
Aluminum Siding
Wood Shakes
Brick Veneer
Stone Veneer
Solid Brick
 
Home Enhancements
Check any that apply to your home.
Burglar Alarm
Fireplace
Swimming Pool
Central Vaccuum
Trash Compactor
Solar Panels
Intercom System
Electric Air Cleaner
Sauna
Stained Glass
Air Conditioner
 
 
Other Home Enhancements
List the quantity of each that apply to your home.
Garage Door Opener
Skylights
Jacuzzi/Hot Tub
Wet Bar
French Doors
Sliding Glass Doors
Number Of
Bathrooms:
 
Cooling And Heating
Check any that apply to your home.
Wood Stove
Swamp Cooler
Wall Heater With Thermostat
Wall Heater Without Thermostat
Forced AC And Heating
 
 
What coverage are you interested in?
Click here for more info on coverage.
Deductible
Replacement Cost Of Contents
Replacement Cost Of Building
Home Warranty Plan
Mortgage Protection
 
Additional Comments Or Questions