Your home is probably your most valuable asset. For this reason, you should have a homeowner policy that gives you the protection you need at the best possible price. Fill out the preliminary form below and an agent will contact you. We will not distribute your name, e-mail, phone or address to others.

Name Address City State  Zip Work Phone Home Phone E-mail Present Home Insurance Co. Home Now Insured For Date Home Insurance Expires How long at present job? Occupation Soc. Sec.# How long at present address? Number of claims in last 3 years? Square footage of home excluding garage and basement? Year home was built?  TYPE CONSTRUCTION FOUNDATION ROOF 1-Story 1 1/2-Story 2-Story Split Level Bi-Level Frame or Stucco Masonry Veneer Masonry Basement Crawl Space Slab Asphalt Shingle Wood Shingle Tile or Slate Other Age of Roof GARAGE BATHROOMS OTHER FEATURES 1-Car 2-Car 3-Car 4-Car Attached Detached Basement Built-in Car Port # of Full # of Half  Central Air Cond.    Central Vacuum    Security System    Wet Bar    Whirlpool Tub   FIREPLACES BASEMENT DECK, PORCH, PATIO # of Chimneys   # of Hearths   Finished Yes No Sq. Ft. Deck sq. ft. Porch sq. ft. Screened Patio sq. ft.    Pacific Benefit Consultants, Inc. 450 Country Club Rd. Suite 330 Eugene, Oregon 97401 (541) 484-6624 (541) 686-2726 (Fax) (800) 588-8688 (Toll Free)     Home Page   ||   Who We Are   ||   Auto & Homeowners Insurance Commercial Property & Casualty   ||   Life & Financial Services Health Ins.   ||   Senior Ins. Services   ||   Group Health   ||   Consulting Services Map to Our Office   ||   Contact Us   ||   Links   ||   Site Map