Dwelling and Homeowners

Additional Location Supplemental Application
(Complete in addition to Dwelling Fire Application)

PDF icon Additional Location Supp (9/12)

Dwelling Application - Illinois
(DP-1, Market Value)

PDF icon Dwelling App - IL (4/16)

Dwelling Application - Indiana
(DP-1, Market Value)

PDF icon Dwelling App - IN (4/16)

Dwelling Application - Ohio
(DP-1, Market Value)

PDF icon Dwelling App - OH (4/16)

Dwelling Fire Application

PDF icon Dwelling Fire App (2/13)

Homeowner Application

PDF icon Homeowner App (2/12)

In Home Business Supplemental Questionnaire
(Complete in addition to Homeowner Application)

PDF icon In Home Business Supp (6/11)

Protection Class Questionnaire
(Complete for PC 8B, 9 & 10 in addition to Homeowner Application)

PDF icon Protection Class Quest (4/14)

Residential Builder's Risk Supplemental Application
(Complete in addition to Homeowner Application)

PDF icon Residential Builder's Risk Supp (6/07)

Wood/Coal Burning Facility Questionnaire
(Required if wood/coal stove on premises)

PDF icon Wood/Coal Burning Facility Quest (12/02)

About Us

Roush Insurance Services, Inc. is a managing general insurance agency that has been in business since 1990. We offer licensed insurance agents access to the excess and specialty market for risks domiciled in Indiana, Illinois and Ohio.

Industry Links

Our membership in AAMGA, NAPSLO, PIA of IN, IIA of IN and IIA of IL enables us to stay abreast of industry developments and better serve your insurance needs.

Contact Us

Roush Insurance Services, Inc.
PO Box 1060
Noblesville, IN 46061-1060
Toll Free: (800) 752-8402
Phone: (317) 776-6880
Fax: (317) 776-6891
Submissions: quote@roushins.com
Claims: claim@roushins.com
Accounting: accounting@roushins.com
Information: info@roushins.com