Request a homeowners insurance quote from Susman Insurance Agency in Los Angeles. We compare carriers for you, including homes in escrow. A licensed agent reviews every request.

1. Name (required)
2. How did you find us? (required; choices: Search engines / Social media / News story / Referral / I am a current client of Susman Insurance)
3. Name of Referral (required; only when applicable)
4. Are you working with one of our Agents? (required; choices: Yes / No)
5. Agent’s name (required; only when applicable)
6. Cell Phone (required)
7. Home Phone (required)
8. Email Address (required)
9. Date of Birth (required; date)
10. Sex (required; choices: Male / Female)
11. Social Security Number (Skip if in California) (optional)
12. Occupation (required)
13. Marital Status (required; choices: Single / Married / Divorced / Widowed)
14. Name of Spouse (required; only when applicable)
15. Cell Phone Number of Spouse (required; only when applicable)
16. Email Address of Spouse (required; only when applicable)
17. Date of Birth of Spouse (required; date; only when applicable)
18. Gender of Spouse (required; choices: Male / Female; only when applicable)
19. Occupation of Spouse (required; only when applicable)
20. Address (required)
21. Address line 2 (optional)
22. City/Town (required)
23. State/Region/Province (required)
24. Zip/Post Code (required)
25. Country (optional)
26. Have you had any claims in the last 5 years? (required; choices: Yes / No)
27. Is the Mailing address same as property address? (required; choices: Yes / No)
28. Address (required; only when applicable)
29. Address line 2 (optional; only when applicable)
30. City/Town (required; only when applicable)
31. State/Region/Province (required; only when applicable)
32. Zip/Post Code (required; only when applicable)
33. Country (optional; only when applicable)
34. Dwelling Style (required; choices: single family / duplex / triplex / fourplex / none)
35. Occupancy type (required; choices: Primary home / Secondary home)
36. Is there a Basement? (required; choices: Yes / No)
37. What % of basement is finished? (required; only when applicable)
38. Are you in escrow? (required; choices: Yes / No)
39. Will you be moving in within 30 days? (required; choices: Yes / No; only when applicable)
40. Please explain why you will not be moving in within 30 days. (required; only when applicable)
41. Closing date of escrow (required; date; only when applicable)
42. How will title be held (insured names, trust, LLC?) (required; only when applicable)
43. How will the property be occupied? (required; choices: Owner / Tenant / Vacant / Short term rental; only when applicable)
44. Purchase price (required; only when applicable)
45. Address (required; only when applicable)
46. Address line 2 (optional; only when applicable)
47. City/Town (required; only when applicable)
48. State/Region/Province (required; only when applicable)
49. Zip/Post Code (required; only when applicable)
50. Country (optional; only when applicable)
51. Purchase date (Month and year only) (required; only when applicable)
52. Purchase price (required; only when applicable)
53. Address (optional; only when applicable)
54. Address line 2 (optional; only when applicable)
55. City/Town (optional; only when applicable)
56. State/Region/Province (optional; only when applicable)
57. Zip/Post Code (optional; only when applicable)
58. Country (optional; only when applicable)
59. Do you have a prior insurance? (required; choices: Yes / No; only when applicable)
60. Who is the property currently insured with (required; only when applicable)
61. Is your policy currently being non-renewed? (required; choices: Yes / No; only when applicable)
62. Reason for non-renewal (required; only when applicable)
63. Expiration date of current policy (optional; date; only when applicable)
64. Who is listed on the title? (required; only when applicable)
65. Property year built (required)
66. Square footage of home (required)
67. Number of stories (required; choices: 1 / 1.5 / 2 / 2.5 / 3 or more / none)
68. Type of garage (required; choices: Attached - Garage, with no living space above, that is connected to the home. / Detached - Garage or carport that is not connected to the home. / Basement - Garage entrance is on the same level as the basement. Only found in homes with a basement foundation. / Built in - Garage, with living space above, that is connected to the home on the ground level or first level. / Carport - Covered structure that is not enclosed which is attached to the home. / None - Do not have a garage.)
69. Number of cars (required; choices: 1 Car / 2 Cars / 3 Cars / 4 Cars / 5 Cars / none)
70. Type of roof (required; choices: Architectural Shingle - Also known as dimensional or laminated shingles with a more textured look than asphalt-fiberglass. / Asphalt-Fiberglass- Shingles of uniform size and shape with a grit texture. Also known as 3-tab shingles / Clay or Concrete Tile -Tiles including Spanish or mission tiles. Typically found in the Southwest. / Slate - Shingles made of hard rock. Typically found on older homes. / Metal - Roof covering made of steel, aluminum or copper. / Wood - Shingles or shakes made of wood. Typically found on a sloped roof. / Comp Over Wood - Shingles or shakes made of wood with a layer of asphalt or architectural shingles on top. / Modified Polymer - Roof covering made of asphalt reinforced with plastic or rubber. / T-Lock - Shingles that interlock to resemble the letter "T". / Asbestos - Typically found in the Southeast. Could contain algae stains.)
71. Roof shape (required; choices: Gable - Has "A" frames. This is a common shape. / Hip - Has 4 sides that slope down to the outer walls of the home. Resembles a pyramid shape. / Gambrel - Resembles a barn shape. / Flat - Has little or no slope. May be covered in tar, gravel, rolled, or built up material. / Shed - Has 1 slope. May be known as a half-gable roof. / Complex - Has multiple levels, slopes, angles or styles.)
72. Siding Type (required; choices: Vinyl - Plastic material. Commonly used in newly built homes. / Aluminium/Steel - Metal material. / Brick/Masonary Veneer - Brick veneer or concrete veneer finish. Typically on frame construction. / Cement Fiber - Composite material made of sand. cement and cellulose fibers. / Clapboard - Wood boards attached in overlapping, horizontal rows. Also called lap siding, weatherboard, or bevel siding. / Stone Veneer - Stone veneer finish. Typically on frame construction. / Stucco - Cement type finish. / Wood - Hardwood material such as shingles or shakes. Excludes clapboard. / Adobe - Clay material. Typically found in the Southwest. / Asbestos - Cement siding type that contains asbestos, was popular from the 1920's to 1960's. / Exterior Insulation (EIFS) - Exterior insulation and finish system resembling stucco.)
73. Number of bedrooms (required; choices: 1 bedroom / 2 bedrooms / 3 bedrooms / 4 bedrooms / 5 bedrooms / 6 bedrooms / none)
74. Number of full bathrooms (required; choices: 0 / 1 bathroom / 2 bathrooms / 3 bathrooms / 4 bathrooms / 5 bathrooms)
75. Number of half bathrooms (required; choices: 0 / 1 half bathroom / 2 half bathrooms / 3 half bathrooms / 4 half bathrooms / 5 half bathrooms)
76. Number of fireplaces (required; choices: 0 / 1 fireplace / 2 fireplaces / 3 fireplaces)
77. Foundation type (required; choices: slab / crawlspace / post and pillar / basement)
78. Flooring type (% of Hardwood, tile, carpet, marble) (required)
79. What year was the roof updated? (required)
80. What year was the electrical system updated? (required)
81. Is the property on circuit breakers? (required; choices: Yes / No)
82. What year was the plumbing updated? (required)
83. What year was the heating/air conditioning updated? (required)
84. Is there a pool or spa? (required; choices: Yes / No)
85. Is pool or yard fenced? (required; choices: Yes / No; only when applicable)
86. Do you have a dog? If so, what is its breed and does it have a biting history? (required)
87. Does the home have a burglar alarm system? (required; choices: Yes / No)
88. Type of burglar alarm? (required; choices: Local -The alarm is heard in your premises, only. / Central - A system that notifies a third party monitoring company that contacts you, police, fire, or other emergency service. / Smart - A system that notifies you through email, text message or a mobile application.; only when applicable)
89. Does the home have a fire alarm system? (required; choices: Yes / No)
90. Type of fire alarm? (select all that apply) (required; choices: Local -The alarm is heard in your premises, only. / Central - A system that notifies a third party monitoring company that contacts you, police, fire, or other emergency service. / Smoke Detector - Not applicable for tenant. / Smart - A system that notifies you through email, text message or a mobile application.; only when applicable)
91. Does the home have interior fire sprinkler systems? (required; choices: Yes / No)
92. Water leak detection? (required; choices: No / Valve Closure / Central Monitor / Valve Closure with Central Monitor)
93. Do you have solar panels? (required; choices: Yes / No)
94. How many solar panels? (required; only when applicable)
95. Are they owned or leased? (required; choices: owned / leased; only when applicable)
96. Household employees? (required; choices: Part time help / Full time help / Live in help / None)
97. Are you an AARP member? (required; choices: Yes / No)
98. AARP member number? (required; only when applicable)
99. Would you like to schedule any high value items? (required; choices: Jewelry / Fine Art / Collectible items / Purses / None)
100. Jewelry amount (required; only when applicable)
101. Would you like a quote for auto insurance to get multi policy discount? (required; choices: Yes / No)
102. Also quote the following (required; choices: Flood insurance / Mortgage protection insurance / Life Insurance / Business Insurance / Other / None; only when applicable)
103. Additional remarks (optional)
104. Attach current home or auto dec sheet, mortgagee info or alarm certificates (required; choices: Yes / No)
105. File upload (required; only when applicable)
106. Would you like a quote for Earthquake Insurance? (required; choices: Yes / No)
107. Would you like a quote for Flood Insurance? (required; choices: Yes / No)

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