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Rockdale Life Agency, Inc
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Do you live at this property?

Yes
No
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Approximately what year was the property built?

2010-2022
2000-2009
1990-1999
Before 1990
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Approximately how many square feet?

["Any Square Feet","Less Than 500 SF","501-750 SF","751-1,000 SF","1,001-1,250 SF","1,251-1,500 SF","1,750-2,000 SF","2,001-2,250 SF","2,251-2,500 SF","2,750-3,000 SF","3,001-3,250 SF","3,251-3,500 SF","3,750-4,000 SF","4,001-4,250 SF","4,251-4,500 SF","4,750-5,000 SF","5,001-5,250 SF","5,251-5,500 SF","5,750-6,000 SF","6,001-6,250 SF","6,251-6,500 SF","6,750-7,000 SF","7,001-7,250 SF","7,251-7,500 SF","7,750-8,000 SF","8,001-8,250 SF","8,251-8,500 SF","8,750-9,000 SF","9,001-9,250 SF","9,251-9,500 SF","9,750-10,000 SF","More than 10,000 SF"]
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"751-1,000 SF"
  • Any
  • 10k+
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Are you replacing an existing policy?

Yes
No
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Do you need personal property coverage?

Less than $10,000
$10,000
$15,000
$20,000
$25,000
$25,000+
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Do you need liability coverage?

Less than $100,000
$100,000
$300,000
$500,000
$1,000,000
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What is the deductible amount?

$250
$500
$1,000
$2,000
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Do you have any potential discounts?

(check any that apply)

None
Deadbolts
Smoke Alarms
Fire Extinguishers
Nearby Fire Hydrant
Manned Fire Station within 5 Miles
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Do you own any of these dog breeds?

(check any that apply)

None
Rottweiler
Pitbull
German Shepherd
Chow
Doberman
Wolf Hybrid
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Do you have any past claims?

(check any that apply)

None
Weather
Theft
Vandalism
Water
Fire
Other
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Is your home located in a floodplain?

Yes
No
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What is your full name?

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What is your email address?

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What is your phone number?

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