FREE QUOTE                                                                        

 

                           

                                                                                   



If you live in East Texas and would like an insurance
quote, please fill out and submit the form below.
Don't forget to include your phone number and email
address so that we may contact you promptly.
Thank you for the opportunity to serve you!

                    

 

   

HOME QUOTE FORM

Personal Information * PLEASE FILL IN REQUIRED FIELDS
*First Name
*Last Name
*Physical address of home
*City
*State
*Zip
*Phone
Fax
*Email address

Home Risk Information ALL FIELDS REQUIRED
*County house is LOCATED in. (example Bexar, Harris, Smith, etc.)
*Market value (USD)
# of stories
*Type of roof, (example composition, metal, etc)
*What is the home made of? (example brick, wood frame, etc)
*Year built (example [mm/yyyyyy])
*Square footage
Is the risk within a fire protection district?
*Name of fire department responding
*Distance from the Fire station (road miles)
Is the home in the city limits?
Is the house within 1000 feet of a fire hydrant?

Occupancy ALL FIELDS REQUIRED
    Is the home: Owner occupied (Homeowner's family)

Vacant
(No occupancy; no content)

Unoccupied
(Has content, but no dwellers)
Is the home occupied by more than one family?
Is business conducted on any part of the premises?
If YES, explain;
Any previous losses or claims?
If so, how many years ago
explain type of loss / claim
Details
Watercraft exposure?
Is this the only place you maintain a residence?
If NO, explain

Miscellaneous Underwriting ALL FIELDS REQUIRED
Do you own any animals?
Animal type?
How many animals?
Is there a swimming pool
Is it fenced in?
Is under contract for sale?

New Home Information ALL FIELDS REQUIRED
Is the home a new purchase?
If YES, purchase price (USD)

Previous Insurance Coverage ALL FIELDS REQUIRED
Has the risk been cancelled or declined by another insurance carrier?
Prior insurance carrier (Insur Co)
POLICY#
Amount of insurance (USD)
Alamo Auto Insurance of East Texas. Designed by www.greeneyesolution.com