- HOME INSURANCE - Homeowners Insurance Quote Form Fill out the following form as completely as possible. Once you have completed the form, click Submit to send your information to Insurance Discounters of Ohio. We will handle your request shortly. Please enable JavaScript in your browser to complete this form.Name *FirstLastStreet *City *StateOhioKentuckyIndianaTexasZip/Postal CodeEmail *Primary Phone Number *Date of Birth *Social Security NumberDo you currently have insurance?YesNoCurrent PremiumCurrent Insurance ProviderMonths With CompanyCurrent Policy End DateYear Your House was built?Roof TypeConstruction TypeDate of Original PurchaseNumber of families living in home?Number of bedrooms?Liability LimitDeductible AmountSquare Footage *Estimated Value * *DogsYesNoPoolYesNoClaims/Property Losses in Past 5 Years (Please Explain)How did you hear about us?Submit