936-828-2503 103 Commercial Cir. Ste 101 Conroe, TX 77304

Homeowners/Townhouse Quote Form (Ehlers)

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Are You Currently working with someone within Agency? *

Personal Information

First Name *

Last Name *

If Spouse or other name on Deed, please provide information

Street *

City *

State *

ZIP / Postal Code *

E-Mail Address *

Primary Phone Number *

Alternate Phone Number

Date of Birth *

Current Information

Is home currently vacant or for sale? *

Is Home ever Rented Out *

Is this your primary residence? *

Do you conduct business on premises? *

If yes to business on premises, please explain

Dwelling Information

Approximate Date of Purchase *

Year Built *

Type of Roof *

Roof Replacement Year *

Foundation Type *

Outside Structure Type *

Approximate Living Area Square Footage *

How many bedrooms? *

How many full baths? *

How many half baths? *

Kitchen Counter Tops *

Any Fireplaces? *

Any Wood burning Stoves? *

Number of Stories *

What type of Flooring do you have? Please provide approximate % *

Any specialty rooms?

Garage (How many cars?) *

Attached or Detached Garage *

Monitored Burglar Alarm *

Monitored Fire Alarm *

Fire Extinguisher *

Trampoline *

Any swimming pool? *

If yes to swimming pool or trampoline, are they behind a fence?

Dogs *

If dogs, please list breed. If mixed breed, please list prevalent breed

Any additional structures requiring coverage

Any Skylights? *

Any Solar Panels? *

Are there any decks/porches with 3 or more steps without handrails? *

Any updates to Heating, Electrical, Plumbing?

Any galvanized Plumbing? *

Heating Type? *

Approximate Miles to Fire Station *

Approximate Feet to Closest Fire Hyrant *

Gated Community *

If gated community, are there security guards?

Do you live on more than 1 Acre? *

If yes to more than one acre, how many acres?

Any other animals on premises?

Claims in Past 6 Years Weather or Non Weather

Do you own any toys?

Endorsement or Desire Coverage for jewelry, watches, furs, guns, artwork, collections?

Current Mortgage on Home? *

Escrow Insurance? *

Current Dwelling Coverage *

Current Adjacent Structure Coverage? *

Current Personal Property? *

Current Additional Living Expenses/Loss of Use *

Current Liability Limits? *

Current Medical Payments *

Current Wind/Hail Deductible? *

Current Hurricane Deductible? *

Current All other Peril Deductible? *

Current Carrier *

Current Months with Carrier (Approximate) *

Current Premium *

Any other Information you would like to Share?

Other than premium reduction, what else is important to you? *

How did you hear about us?

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NEW LOCATION:

Conroe Office
PH: 936-828-2503
103 Commercial Cir. Ste 101
Conroe, TX 77304