With our Roots dating back to 1925 Desert Empire Insurance Services Strives to help you formulate real world solutions to protect your assets whether they are at home or at the office.
Contact us by filling out the form below:
Business
Personal
Employee Benefits
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Personal Lines
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Auto
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Homeowners
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Condominium
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Umbrella
Business
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Business
Employee Benefits
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Homeowners
General Information:
Name:
Date of Birth:
Phone Number:
Occupation:
Email Address:
Mailing/Garaging Address:
Insurance Information:
Losses in Past 5 Years:
Details:
Location:
Type:
Primary
Secondary
Pool:
Yes
Yes Fenced
No
Roof Type:
Pets:
Breed:
Any Bite History:
Yes
No
Guarded/Gated:
Yes
No
Country Club Name:
Year Built:
Square Footage:
# Stories:
Construction:
Frame
Stucco
Block
# Car Garage:
Type:
Attached
Detached
Carport
Other Structures:
# Fireplaces:
# Baths:
# Bedrooms:
Custom/Tract:
Station Alarm:
Yes
No
Fire/Burglary:
Fire & Burglary
Fire
Burglary
Liability Limit:
Deductable:
Yes
No
Earthquake:
Yes
No
Workers Comp.
Yes
No
Hours per week:
Servant:
Inservant
Outservant
Scheduled Items Value:
Jewelry
Furs
Silverware
Fine arts
Guns
Golfcart
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