Financial & Insurance Services of Texas - Homeowners Insurance : Quote Request

18601 LBJ Freeway, Suite 140 - Mesquite, TX 75150 - 972-279-1147

Securities and investment advisory services offered through Osaic Wealth, Inc. member FINRA/SIPC. Osaic Wealth, Inc. is separately owned and other entities and/or marketing names, products or services referenced here are independent of Osaic Wealth, Inc.

This communication is strictly intended for individuals residing in the states of GA, IN, LA, MO, NC, OH, TN, TX, UT & WA. No offers may be made or accepted from any resident outside the specific state(s) referenced.

We are licensed to offer Insurance Products in the following states:
Georgia, Louisiana, Texas.


» Name:
Address:
City:
State:
Zip:
» Home Phone:
Work Phone:
» Email:
Age:

Insurance Type:	Single Family Townhouse Condo Renters
If multi-family bldg, how many residential units:	1-4 5-12 12+
Construction Type:	Frame Masonry Masonry Veneer
Year Built:
Nearest Fire Hydrant:	under 1000 feet none
Nearest Fire Department:	1 2 3 4 5 5+ miles
Smoke Detector:	Yes No
Deadbolt Locks:	Yes No
Fire Extinguisher:	Yes No
Central Station Fire Alarm:	Yes No
Central Station Burglar Alarm	Yes No
Swimming Pool:	Yes No
If yes, is it fenced in:	Yes No
Wood Burning Stove:	Yes No
Do you have a dog:	Yes No
Market Value $:
Existing dwelling coverage amount $:
Desired Coverage Amount $:
Liability Limit $:
Deductible:	250 500 1000
Any special coverages:
Current Insurance Company:
Expiration date (or settlement if new purchase):
Any claims past 5 years:
Please use the space below to add comments regarding any special circumstances.