<% 'Dim strName, strEmail, strTelephone, strFax, strAddress, strZipCode, strBestTimeToCall, _ 'strAnyClaims, strYesClaims, strConstructionStyle, strDwellingType, strConstructionType, _ 'strYearBuilt, strCurrentInsured, strSquareFootage, strLiabilityLimit, _ 'strDeductible, strLimitOfJewelery, strLimitOfFineArts, strDevice1, strDevice2, _ 'strDevice3, strDevice4, strDevice5, strDevice6, strDevice7, strAdditionalCoverages strName = "" strEmail = "" strTelephone = "" strFax = "" strAddress = "" strZipCode = "" strBestTimeToCall = "" strAnyClaims = "" strYesClaims = "" strConstructionStyle = "" strDwellingType = "" strConstructionType = "" strYearBuilt = "" strCurrentInsured = "" strSquareFootage = "" strLiabilityLimit = "" strDeductible = "" strLimitOfJewelery = "" strLimitOfFineArts = "" strDevice1 = "" strDevice2 = "" strDevice3 = "" strDevice4 = "" strDevice5 = "" strDevice6 = "" strDevice7 = "" strAdditionalCoverages = "" %>
RV Application - Auto Application - Homeowners Application
Motorcycle / ATV Application - Pleasure Boat / Personal Watercraft Application

Homeowner Application

<% Sub HomeOwner %>

* Name: ">
* Email Address: ">
* Telephone: ">
Fax: ">
* Address:
* Zip Code: ">
Best time to call: ">

* Any claim in the last three years? > Yes > No
If yes, please exlplain:
* Construction Style:
* Dwelling Type:
* Construction Type:
* Year Built: ">
* Current Insured : ">
Square Footage (if known): ">
* Liability Limit:
* Deductible:
Limit of Scheduled Jewelery: ">
Limit of Scheduled Fine Arts: ">
Protective Devices: > Dead Bolt Locks
> Local Burglar Alarm
> Smoke Alarm
> Central Burglar Alarm
 > Central Fire Alarm
> Fire Extinguisher
> Sprinkler System
Please list any additional coverages you require or any additional information necessary:

* - Denotes Required Field
<% End Sub %> <% If Request.ServerVariables("REQUEST_METHOD") = "POST" Then strName = Request.Form("name") strEmail = Request.Form("email") strTelephone = Request.Form("telephone") strFax = Request.Form("fax") strAddress = Request.Form("address") strZipCode = Request.Form("zipcode") strBestTimeToCall = Request.Form("besttimetocall") strAnyClaims = Request.Form("anyclaims") strYesClaims = Request.Form("yesclaims") strConstructionStyle = Request.Form("constructionstyle") strDwellingType = Request.Form("dwellingtype") strConstructionType = Request.Form("constructiontype") strYearBuilt = Request.Form("yearbuilt") strCurrentInsured = Request.Form("currentinsured") strSquareFootage = Request.Form("squarefootage") strLiabilityLimit = Request.Form("liabilitylimit") strDeductible = Request.Form("deductible") strLimitOfJewelery = Request.Form("limitofjewelery") strLimitOfFineArts = Request.Form("limitoffinearts") strDevice1 = Request.Form("device1") strDevice2 = Request.Form("device2") strDevice3 = Request.Form("device3") strDevice4 = Request.Form("device4") strDevice5 = Request.Form("device5") strDevice6 = Request.Form("device6") strDevice7 = Request.Form("device7") strAdditionalCoverages = Request.Form("additionalcoverages") If (strName <> "") AND _ (strEmail <> "") AND _ (strTelephone <> "") AND _ (strAddress <> "") AND _ (strZipCode <> "") AND _ (strAnyClaims <> "") AND _ (strConstructionType <> "") AND _ (strYearBuilt <> "") AND _ (strCurrentInsured <> "") AND _ (strLiabilityLimit <> "") AND _ (strDeductible <> "") Then %> <% Call HomeOwner End If Else Call HomeOwner End If %>