Lone Star Insurance Agency

 

Property Quote
 

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Instructions :
Please read the disclaimer at the bottom of this page before completing this quote form.  Complete this property quote form and we will compare pricing with several different companies.  We will find you the lowest rate from those companies and inform you of the down payment/payment options available to you.
Please use (mm/dd/yyyy) for all dates on this application.
 

Insured Information

Last Name , First Name :        

 
Address :  
City :  
State :                            Zip :
County :  
How many years in current home:  

 

  
If less than 3 years in current residence complete question below, otherwise skip.

Previous Address, City, State, Zip               

Work phone number including area code :

Home phone number including area code :
Fax phone number including area code :
Are you currently insured ?
What is your email address ?
Do you consider your credit in the last 5 years
Repossessions in the last 5 years  
Bankruptcy in the last 5 yrs  
   

Resident # 1

  Information
Name Last, First     
Soc. Sec.  Number  
Date of birth  
Marital Status  
Sex  
U.S. Citizen  
Occupation  
Employer  
Years at  job  
   

Resident # 2 

  Information
Name Last, First
Soc. Sec. Number
Date of birth
Marital Status
Sex
U.S. Citizen
Occupation
Employer
Years at  job
 
Structure Information
Construction
Roof  
Foundation  
Year Built  
Square Feet  
Central Heating/Air Conditioning  
If not, how do you heat your house?  
This dwelling has a  
How many car garage/carport   
Garage/Carport is  
Occupied by  
Age of Roof     years
Number of rooms  (not including garage)
Full Bathrooms  
Half Bathrooms  
Pool\Hot Tub\Trampoline  
Fence  
Self-latching Gate  
Vacant or Unoccupied  
Year Purchased  
Purchase Price  
Does wiring meet current standards      Year Updated
Does plumbing meet current standards      Year Updated
Number of stories  
Seasonal Dwelling  
In city limits  
Business Activity  
If so, please explain  
Distance to Fire Hydrant  
How far to Fire Dept.  miles
Name/city of resp. Fire Dept.  
Fireplace   
Fire/Burglar Alarm      If yes, is the alarm 
Dwelling Occupied during Day  
Animals     Type (be specific)
   
Coverage Information
Dwelling Value Amount  
Personal Property Amount  
Liability Limit  
Current deductible
Current Insurance Company
Current premium
 
Mobile Home Information (if you do not have a mobile home, skip this section, otherwise complete this and "Structure Information")
Year  Built  
Make
Model
Width x Length  x   ft.
Roof
Siding
Value
Serial #
Fireplace
In park
If yes, park's name
If yes, # of spaces
On your property
Is Unit 1 or 2  sections   

 
Extra Information
Prior Insurance   
If so, was the policy cancelled or non-renewed  
If yes, expiration date (mm/dd/yy)   
New Loan    
 
Losses (past 5 years)   Type:   Date: (mm/yyyy)   Amount Paid:
       
     
     
     

 
                   
Property Quote Submittal
Please read the disclaimer and  verify that all the information you have entered is correct.  Then  click on the Submit button to send us your information:  
Property Quote Disclaimer
Thank you visiting our property insurance online quote form.  This form can be used to get a property insurance quote, however the fastest way to get an  insurance quote is to call us.   After submitting your information you will be contacted by a sales representative within 72 hours, to discuss your quote.

Your information will not be sold to any outside vendors.  All insurance companies have a variety of rates based upon several factors including but not limited to: location of property, type of construction, protective devices, claims experience, credit history, age, etc...  By submitting your information you are authorizing us to run consumer related reports as required by the companies we represent. 

Our online quote form has a basic set of questions that will greatly reduce the amount of processing time for our agents,  but someone will still need to call you back in order to discuss your quote with you. 

 

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Send mail to management@lonestarinsuranceagency.com with questions or comments about this web site.
Copyright © 2003 Lone Star Insurance Agency
Last modified: 12/06/03