Daroy Insurance Agency
Serving our Delta community since 1997
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Submit this form for a Homeowners, Landlord or Renters quote.
NAME
First
Middle
Last
ADDRESS
Street
City
State
Zip
PHONE
Home
Work
Cell
E-MAIL ADDRESS
POLICY TYPE
Homeowners?
Landlord?
Renters?
ADDRESS OF PROPERTY TO INSURE
CLAIMS
Describe Loss and Date
BUILDING INFORMATION
Year Built?
1 or 2 Story
Single Family, Duplex,Triplex?
GARAGE INFORMATION
1,2,3 or 4 Car?
Attached or Detatched?
EXTERIOR INFORMATION
Woodsiding or Stucco?
ROOF
Comp, Tile, Flat, Wood, etc?
INTERIOR INFORMATION
Standard, Custom or Luxury?
FLOORING
Carpet, Tile, Hardwood or?
BATHROOMS
Full Baths?
Half Baths?
ADDITIONAL FEATURES
Sliding Glass Doors?
Decks?
Built In Bookcases?
Sky Lights?
Porch?
Fireplaces?
Air Conditioning?
Over Hang?
COMMENTS
CURRENT COVERAGE
ADDITIONAL QUOTES
Home Warranty?
Earthquake?
Flood?
Daroy Insurance Agency
9040 Brentwood Blvd #C, Brentwood, CA 94513
(925) 634-9999 Phone, (925)634-9980 Facsimile
Calif. State License #0C01541