Texas Homeowner's Insurance

Step 1 of 2: Quick Quote Information

Contact Information:

*Contact Person:*
*Email Address:*
*Phone Number:*
*Best Time to Call:*	xx:xx am or xx:xx pm

Property Information:

*Propery Address :*
*Unit #:*
*City:*
*State:*	*Texas*
*Zip Code:*

Is the dwelling your ?	Primary Residence
	Tenant or Family Occupied

Dwelling Type :	Single Family Home
	Duplex
	Townhome or Condo
	Modular or Mobile Home

Construction :	Brick
	Frame or Siding
	Log
	Other

What year was the home built?
What is the square footage ?

Coverage Limits:

Is you home insured now?	Yes No

If "Yes" for how much:

Do you want or have?	Replacement Cost
OR	Actual Cash Value

Sale or Purchase Price:

Enter Personal Property Value:

*Select Liability Limit:*

Is there anything else of value you need to make sure you have covered?

List here with approximate value?

Discount Questions:

Would you consider getting auto insurance with us? Yes No

Are you a senior citizen ?	Yes No
Is your roof hail resistant?	Yes No
Do you own a fire extinguisher?	Yes No
Do you have dead bolts?	Yes No

Please tell us want type of alarms you have if any?
Monitored Burglar, Smoke and Fire
Monitored Burglar & Fire
Monitored Burglar
Non-Monitored Burglar, Smoke and Fire
Non-Monitored Burglar & Fire
Non-Monitored Burglar

Smoke Detectors	Other

Please tell us, what's on your mind:

Please note ANY special situations or concerns you have or you think we need to know about. Thanks...

Please double check your information before you submit. Thanks!!!