Roger Collins Agency
A1 Insurance and Financial Services LLC

Homeowners Insurance Quote
We would like to provide you with a free, no-obligation homeowners insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for purposes of this quote only.

Name
Date of birth
Address
City
State
Zip
Day Phone
Evening Phone
email
Best time to call
County
Miles to closest fire station
Feet to closest hydrant
Current insurance company
Current premium
Renewal date
Additional owner name
Date of birth
Year built
Construction type Brick / Percentage
Frame / Percentage
Finished square footage
Home type
Security
(check all that apply)		 Central Alarm
Fire Alarm
Police Alarm
Smoke/Fire Detectors
Deadbolt Locks
Fire Extinguisher
Foundation Basement
Crawl Space
Slab
% Finished
Garage
Number of bedrooms
Number of bathrooms
Fireplace
Pool
(check all that apply)		 None
Above Ground
In Ground
Diving Board
Slide
Fenced pool
Fenced Yard
Trampoline
Desired coverage Dwelling
Personal Property
Liability
Medical
Sewer Back Up
Jewelry
Any business exposure?
If yes, what kind?
Deductible
Year updated Furnace
Roof
Plumbing
Electrical
Electrical Service Amps
Circuit Breakers
Fuses
Purchase Date
Number of claims in last 3 years
How did you hear about us?

In order for us to generate accurate rate quotes for you , the insurance companies may need to run various reports.  If you have any question or concerns, please contact us.