Khalsa Insurance Agency
 
California License # 0F89805
 
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Home / Renters / Condos Insurance Quote Form...
 
Full Name:
Address:
City:
State
ZIP:
Phone:
Home Phone Day Time Phone
   
E-Mail Address:
Who is this Quote for?
   
  Quote Type
   
Select Quote Type:
   
  Home Info.
   
Month of Purchase of Home?
Purchase Price: $
Type of Home:
Year Built:
Type of Construction:
Square Feet:
   
  Electrical & Security Info.
   
Electrical System:
Security Alarm:
Central Air Conditioning:
   
  Home Structure Info.
   
No. of Fire Places:
No. of Bathrooms
No. of Bedrooms:
Type of Garage:
Swimming Pool:
   
Have you made a Claim in the
Past 5 Years?
   
Your Current Home Insurance Carrier:
   
 
 
 
 
 
 
 
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