Texas Homeowners Insurance Quote
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Personal Information
*
Required Field
Your Name :
*
Type if Known
Recommend Coverage
HO1 Basic
HO2 Extended
HO3 Broad All Risk
Fire Pollicy
Rental
Dwelling
Vacant Property
Property
Address:
*
City:
*
State:
TX
Zip Code:
*
County:
*
Social
Security Number
*
Not Required, But may get you a lower rate
HO1 and Dp1
only issued without SSN
Date of
Birth:
*
Email:
*
Home Phone:
*
Cell or alt Phone:
Dwelling Information
Year Home was Built:
or Approx
*
*
Purchase Date
Home Usage:
*
Single Family
Dwelling
Town House
Multi Family
Condo Unit
Duplex
3 Plex
4 Plex
My Primary Home My Second Home Rented to others
Vacation Home
Vacant Home
Approx Sq. Ft.
*
Number of Stories:
*
1 Story
2 Story
3 Story
4 Story
Number of
units:
*
1 Family
Duplex
Tri Plex
Type of
Construction
*
Brick Veneer
Hardy Board
Wood
Stucco
Stone
Brick
Steel
Aluminum Siding
Block
Hollow Tile
Abestos Siding
Other
Other
Type of Roof:
*
Composition
Wood Shingles
Metal Roof
Aluminum Shingle
Tar and Gravel
Terra Cotta
Slate
Rubber roof
Other
Garaging Facilities
None
Attached 1 Car
Attached 2 Car
Attached 3 Car
Detached 1 Car
Detached 2 Car
Detached 3 Car
Carport 1 Car
Carport 2 Car
Is there A
Pool ?:
*
Yes
No
If Yes, Is it Fenced or
Gated
Yes
No
Is the Dwelling within 500 ft
of a lake, pond or large body of water?
*
Yes
No
Nearest Fire
Station:
*
Select Miles
1
2
3
4
5
6
Over 6 Miles
*
Distance to fire hydrant
0 - 500 ft
501 - 1000
more than 1000
None
Prior Loss Claims? :
*
Type:
Date (mm/yy):
Amount paid:
Protective Devices?
*
None
Burglar / Fire Monitored Alarm
Burglar Monitored Alarm
Fire Monitored Alarm
Burglar Local Alarm
Fire Local Alarm
Burglar / Fire Local Alarm
Home Updates?
*
Enter date or year of most recent
updates if Applicable - Approximate if Unknown
Prior Coverage
How is your Credit History?
*
800+ Excellent
750 - 799 Very Good
700 - 749 Good Credit
650 - 699 Above Average
600 - 649 Average
550 - 599 Marginal
500 - 549 Below Marginal
Below 500
In Bankruptcy
( Some
Carriers use credit history to quote)
(
Bad Credit is OK, We have programs for all)
Current
Mortgage?
*
Yes
No
<--- Does your home have
a Mortgage?
Currently Insured?
Yes
No
Current Insurance Co. Name?
*
Current Annual Premium?
*
Expiration Date?
*
Coverage
Requested
Property
Coverage.
*
Value of your property
$
Unscheduled Contents
Default is 25K Non Luxury items
$
Liability
Coverage.
*
None
$25,000
$100,000
$200,000
$300,000
$500,000
$1,000,000
Desired Deductible:
*
1 %
2 %
Desired Coverage
Valuation Method
*
Cash Value - ACV
Replacement Cost
Recommend Coverage
Mortgage Co's
Require Replacement Valuation
Hurricane Coverage
Needed?
Yes
No
Comments / Remarks
( Describe
any additional information you feel may be helpful in determining your quote).
My preferred Contact :
*
Email
Call by Phone