Kyllo Insurance Services NW, Inc

Homeowner's Quote

Policy Holder
Contact Name *
Email *
Phone Number
Property Location
Address
City
State
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Current Insurance Information
Company Name
Current Annual Premium
Expiration Date
Deductible Desired
Amount of Liability
Earthquake Coverage Desired? Yes  No
Have you filed for bankruptcy within the past 7 years? Yes  No
Dwelling Information
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Year Constructed
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Type of Construction Wood
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(check all that apply)		 Dead Bolts
Smoke Detectors
Fire Extinguisher
Central Station Fire Alarm
Central Station Burglar Alarm
Home Located within 5 miles of Fire Station
Home Located within 1000 feet of a Fire Hydrant
Swimming Pool
Trampoline
Home located within City Limits
Claims
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  Amount Paid Claim Type Description
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Personal Property
Estimated value of your personal property:
Jewelry & Watches
Furs
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Stamp and Coin Collections
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Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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CANBY OFFICE:

227 NW 3rd Avenue Suite 102

Canby, OR.  97013

(503) 829-2255

 

Portland office:                                                                

 707 SW Washington Street Suite 1418

Portland, OR.  97205

(503) 226-3741

CLAIMS REPORTING  

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