Homeowners Insurance Quote

While we can offer you a quote, we cannot bind or place coverage in effect over the internet.  No policy can be issued until we have met with your personally and you have signed the appropriate application.

If you need assistance with any of these forms, you may reach us by telephone during normal business hours for assistance.

Once you hit the “submit” button at the bottom of this form, you will receive a responce within 24 hours. However, if we have not responded to your request within 24 hours, please telephone us to confirm that your request was received.

Please fill out the form below and we will e-mail an estimated quote back to you.  All quotes are subject to company underwriting requirements.

Fields marked with an * are required

* Name:
* Address:
* City:
* County:
* State:
* Zip Code:
* Date of Birth:
Number where you can be reached:
* Do you own or rent?:
Own Rent
* Marital Status:
Single Married
Occupation:
* Email:

* Type of Residence:

Single Family Town House Condo
Apartment Mobile Home
* Year Built:
* Type of Construction:
Brick Frame
Number of Stories:
Number of Families:
* Limit of Insurance Needed on Residence:
(Homeowners Insurance Only)
* If Renting, Limit of Insurance Needed for Personal Property:
* Liability Limit:
* Medical Expence Limit:
* Deductable:
* Miles to Nearest Fire Department:
* Feet to Nearest Fire Hydrant:
Number of Smoke Detectors:
* Any Alarm Systems?:
Fire Burglar Both None
* Do you have a swimming pool?:
In Ground Above Ground None
If yes, is it fenced in?:
Yes No
* Do you have any pets?:
Yes No
If you have a dog, what breed of dog is it?:
Current Insurance Company Name:
* Policy Renewal Date:
Any items you would like Scheduled (Please list along with value):
* Any claims in the last 3 years?:
Yes No
If yes, please explain:
Any special instructions:

 

 

Home Mutual Insurance Co., Inc. | Home Insurance Agency of Tell City, Inc | German Mutual Insurance Agency


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