Home Quote

Garrett Insurance Agency, Inc.

Home Quote

Texas Residents Only

It is our goal to provide you with the most ACCURATE quote possible. In order for us to achieve that goal, please complete all questions on this form. Any unanswered or misrepresented questions could affect the accuracy of the quote.

PERSONAL INFORMATION
(Please MAKE SURE your email address is correct. I have a lot of quotes returned to me due to bad email addresses.)

Your Full Name:

Do You Smoke?

Your Spouse's Full Name
if applicable

Spouse Smoke?

Address:

- Mailing

City:

County:

State:

TEXAS - Quotes for TX Residents Only

Zip Code:

E-Mail:

Phone Number:

- Optional

ADDITIONAL RATING INFORMATION

Current Insurance Company:

Expiration Date:

Policy Number

How Long at this Address:

If Less than 5 Years
Previous Address:

Your Date of Birth:

55+ will get discount

Your Spouse's Date of Birth
if applicable

Your Social Security #:

xxx-xx-xxxx

Your Spouse's
Social Security #
if applicable

xxx-xx-xxxx

HOME LOCATION INFORMATION

Physical Address of Home:

City:

County:

State:

TEXAS

Zip Code:

Is Home:

If OUTSIDE City Limits,
Please answer following:

Distance to Fire Station:

Distance to Fire Hydrant:

Distance from City Limits:

Name of Responding
Fire Department:

HOME RATING INFORMATION

Year Home was Built:

Number of Stories:

Total Living Area
Square Feet:

Construction:

Basement:

Attached Garage:

Number of Bedrooms:

Number of Bathrooms:

.5 = 1/2 bath

Fireplace:

Balcony/Deck

if Yes - Approx. SQFT

Roof Material:

Age of Roof

Air Conditioning:

Business on Premises

Swimming Pool on Premises

if yes, is Pool completely fenced

Trampoline on
Premises

(if yes, we can not provide you with a quote)

Home on 10 or more acres?

Number of Mortgagees

HOME VALUE

Estimated Value to COMPLETELY REPLACE Home in case of a TOTAL Loss
(This figure will be used for the amount of insurance on your home)

DEDUCTIBLE OPTIONS

Please Choose a Deductible:

higher = lower premium

LOSS HISTORY

ANY LOSSES in Past 3 yrs:

If YES, Please
Provide Details:
(date,type,amount paid)

POSSIBLE CREDITS

Is Home Equipped with:
(Proof Required)

Central Alarm-Burglar or Fire/Smoke
Remote Alarm-Burglar or Fire/Smoke
Local Alarm-Burglar Only
Dead Bolts on all doors, Smoke Detector, Fire Extinguisher

Other Information:
(additional endorsements, etc)

Thank you for completing our online quote form. We will send you a quote (by email) within three to five business days.

Please note this is only a quote and does not bind coverage in anyway.

PLEASE NOTE
We are licensed to sell insurance in the following state(s): TEXAS

We are an Independent
Agent for Allstate

Garrett Insurance Agency, Inc.
"Insurance Excellence Since 1918"