Thank you for your interest in receiving a vacant land quote. This form should only take a few minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.

Are you planning to build on your land?(Required)

No

Yes

This quote form is designed for persons who do NOT plan on building anything on their land. If you are planning on building in the near future it looks like you need a Course of Construction policy (aka Builders Risk Policy). Click the button below to get started with a course of construction quote.

Start Course of Construction Quote

Date you want this policy to start?(Required)

Name(Required)

Email Address(Required)

Mobile Phone(Required)

Can we text you?(Required)

Yes

No

Date of Birth(Required)

Property Address & Mailing Address

Property Address(Required)

Street Address City State ZIP Code

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Ownership Information

Any additional owners listed on the property besides yourself?(Required)

No

Yes

Owner 2: Name

First Name Last Name

Owner 2: Date of Birth

Third Owner?

Yes

Owner 3: Name

First Name Last Name

Owner 3: Date of Birth

Fourth Owner?

Yes

Owner 4: Name

First Name Last Name

Owner 4: Date of Birth

Is the property titled in a name Other Than your personal name(s)?(Required)

i.e. Trust, LLC, Corporation, etc.

No

Yes

Name on title of property(Required)

Do you have a mortgage on this property?(Required)

No

Yes

Property Information

Any structures on the property?(Required)

(Fence, rock wall, shed, buildings, etc)

No

Yes

Please list the structures on this property(Required)

Do you lease the land to anyone?(Required)

No

Yes

Any business use?(Required)

No

Yes

Please describe the business use(Required)

How many acres?(Required)

or enter the lot size if under 1 acre

How will the property be used?(Required)

(building in the future, business use, leased to others, etc)

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Would you like a quote from a specific agent?

How were you referred to us?

Is there anything you want us to know?

Consent(Required)

Like most insurance agencies, Culley Insurance Group uses information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium.

I Agree

All the above information is accurate and true to the best of my knowledge.(Required)

Yes

Would you like to create a user account to manage your submissions?(Required)

Yes, create my account

Not at this time

Username(Required)

Password(Required)

Enter Password Confirm Password

Phone

This field is for validation purposes and should be left unchanged.

Vacant Land Quote

Property Address & Mailing Address

Ownership Information

Property Information

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