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Home Insurance

Home Quotes

Name

Address

City

State

Oklahoma Only

ZIP Code

E-mail Address

Phone #

Best Time to Call

Send Quote Via

E-mail  Phone

Residents Type

Current Home Insurance

Yes  No

If Yes, Current Carrier

Date of Expiration

Social Security Number of all owners

How did you hear about us

Type of Quote Needed
Homeowners Mobile Home

Home Information

How Long At Present Address Year Home Was Built
Sq. Footage
(excluding garage & basement)
# of Claims In Last 3 Years:
sq. ft.
Please List any claims within the past three years

Structure Information
Type Construction Foundation
Roof Type Roof Age  
yrs  
Garage Size Garage Type

Dwelling Information
Deck/Porch/Patio Fireplaces
Deck Sq. Ft. # of Chimneys
Porch Sq. Ft. # of Hearths
 Screened Patio Sq. Ft Wood Burning Stove
Bed Rooms Bathrooms Basements
# of Full
# of Half

Sq. Ft.

Additional Features
Heating System Central Air Central Vacuum
Yes Yes
Security Alarm Fire Alarm Smoke Detector
Yes

Underwriting Questions
Swimming pool Is pool enclosed Trampoline
Inside city limits How many acres Miles to fire dept.
Any Animals If yes what kind
(breed of dogs)
Please list any updates on Wiring (circuit breakers), Plumbing, and list type of heating system if NOT Central Heat/Air
Amount of coverage on Dwelling Deductible

Mobile Home Information

Tied Down Location
   
Size of Home Is Home Skirted
Yes No

 Personal Property Information

How much personal property coverage is required Burglary Coverage Included
Yes No

List additional information which may help us provide you an accurate quote.
Also list any additional items you would like scheduled with $value.

Information submitted will be held confidential and will be used for quote purposes only.
By pressing Submit you are authorizing us to verify any information including credit scoring, if applicable, to provide you with the best rates and most accurate quote.
No Coverage will be bound by this form.

I authorize AIC to use my information in my file to remarket or check other insurance companies they represent, for the overages or polices on my behalf until I revoke this authority, this includes social security numbers, state drivers license numbers, address and phone numbers. Information will be used for insurance purposes only.

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