800 W Williams Street, Suite 231-C
Peakway Market Square
Apex, NC 27502
(919) 267-3063

ABC Insurance Agency is only licensed in the state of North Carolina.

HOMEOWNERS QUOTE FORM

ALL FIELDS ARE REQUIRED FOR AN ACCURATE QUOTE

How did you hear about this website?  

Type of policy needed.  
      
      Renters
      Condo - Contects and limited dwelling coverage of unit
      Condo - Contects and full dwelling coverage of unit
      Homeowners
      Townhome - Contects and limited dwelling coverage of unit
      Townhome - Contects and full dwelling coverage of unit
      Unknown please call me!
    

This is for a home/condo...   
      
      I currently own
      I am buying
    

Name:               Date of Birth:  
Name2:              Date of Birth:  
Street Address:   
City, State Zip:  , 


If Less Than 3 Years
Previous Street Address:  
Previous City, State Zip: , 


Property Address If Other Than Above
Street Address:  
City, State Zip: , 


Phone Number: 
Email:        

Current Insurance Company: 

How many homeowners claims have been filed by the insureds: 
Explain Above: 
               

I currently... 
      
      Own
      Rent
    
Year of Construction? 
Square Footage?       
Number of Bedrooms?   
Number of Bathrooms?  
Number of Half Baths? 
Quality of Kitchen?   
      
      Basic
      Standard
      Semi-Custom
      Custom
    
Number and appoximate square footage of decks?             
Number and appoximate square footage of patios?            
Number and appoximate square footage of front porch?       
Number and appoximate square footage of screened porches?  
Number and appoximate square footage of sunrooms?          
Approximate percentage of vaulted ceilings?                
Any special features in your home? 
Type of Garage? 
      
      None
      Built In
      Attached
      Un-Attached
    
                
      
      
      Single Car
      Two Car
      Three Car
      Four Car
    

Distance to Fire Hydrant? (feet)     
Distance to Fire Department? (miles) 
Burglar Alarm?  
      
      None
      Local
      Central Station
    
Fire Alarm?     
      
      None
      Local
      Local
      Central Station
    
Currently receiving a multi-policy discount? 
      
      Yes
      No
    
Are you also interested in an auto quote? 
      
      Yes
      No
    


CURRENT POLICY
Current Policy Type      
      
      HO2
      HO3
      HE7 Plus
      HE7 Plus 20
      HE7 Plus 21
      Renters
      Condo Policy
      Unknown
    
Current Dwelling Amount  
Personal Liability       
Medical Payments         
Deductable?   
      
      $100
      $250
      $500
      $1,000
      $2,500
    


OTHER COVERAGES
Do you currently have Sewer and Drain Backup coverage?    
      
      Yes
      No
    
   Would you like more information about this coverage?   
      
      Yes
      No
    

Do you currently have Identity Theft Recovery coverage?   
      
      Yes
      No
    
   Would you like more information about this coverage?   
      
      Yes
      No
    

Do you currently have a Personal Umbrella Policy?         
      
      Yes
      No
    
   Would you like more information about this policy?     
      
      Yes
      No
    

Are there any items such as jewelry or collectable listed seperately or needed to be scheduled?
   
   

Best Time to Reach You: 
      Morning (8:30 am - 12:00 pm)
      Afternoon (12:00 pm - 4:30 pm)
      Evening (4:30 pm - 8:00 pm)
    

Comments  


By saying "YES" in box to the right I give consent to order a credit based insurance score. 
If any other answer than yes appears above, a quote will not be complete.

Phone: 919.267.3063
Fax: 866.453.9992
E-mail: agency@abc-insure.com

Address:
ABC INSURANCE AGENCY
800 W. Williams St, Suite 231-C
Apex, NC 27502