.

Homeowner's Insurance Quote

Property Crossing is licensed to sell insurance only in the state of Texas.

Please fill in all the required fields.

 I. APPLICANT INFORMATION
 

First Insured Second Insured
First Name

Middle Name

Last Name 

Suffix if applicable) 

Email

 First Name

Middle Name

Last Name 

Suffix if applicable) 

Email

Both Names To Appear On Policy?  Yes No
Date Of Birth
 Social Sec. No. 
 Date Of Birth
 Social Sec. No. 
Is The Insured Retired?
Yes No		 Years on this job: 
 Is The Insured Retired?
Yes No		 Years on this job: 
Occupation: Employer Name: 
 Occupation: 
 Employer Name: 
Home Phone:  Business Phone: 

 

II. PROPERTY INFORMATION

Property Address: 
 

Street City: State: Zip Code:
Addition: Lot: Block.: #  Of Years:

 
Own or Rent Property? Dwelling Type: Property In A Windpool? If Yes, Exclude Wind?
Own Rent Yes No Yes No

Mailing Address:
Street: City: State: Zip Code:

 

III. INFORMATION

Dwelling Values
Year Built Date Of Purchase Current Market Value Dwelling Square Footage Replacement Cost

Protective Devices

Fire Protection Credit
Automatic Sprinkler Credit
Burglary Protection Credit
Home Security Devices
List Months Dwelling Not Occupied:

General Information

Type Of Occupancy
Construction
If Modular, Please Indicate
Inside City Limits:  Yes No
5 Miles or Less To Fire Station:  Yes No
1000 Feet or Less To Fire Hydrant:  Yes No
Responding Fire Department:
Floor Unit Located On:
Primary Heating System
Roof Type
Does The Roof Have Less Than 5 Years Useful Life Remaining:  Yes No

Renovations
Wiring Type

Update Year: 

Heating Type

Update Year: 

Plumbing Type

Update Year: 

Roofing Type

Update Year: 

Other Policy Information

Prior Homeowners Carrier: 

Expiration Date: Policy Number: 
 

Wind Policy Carrier: 

Expiration Date: Policy Number: 
 

Flood Policy Carrier:    Flood Zone:

Expiration Date: Policy Number: 

 

IV. COVERAGE INFORMATION

Coverages
Dwelling Other Structures Personal Property Loss Of Use Personal Liability Medical Payments
Personal Property Replacement Cost:  Yes No

Deductibles
Other Than Wind And Hail:  Wind And Hail: 

 

V. MORTGAGE INFORMATION

Mortgage Company
Company Address City State Zip Loan Number

 

VI. LOSS INFORMATION

List All Losses In Past 3 Years - CANNOT LEAVE BLANK (if no loss, enter 'none' for date, choose 'None' for Type, and enter 'none' for Amount) 

Loss 1
Date Type Amount

Loss 2

Date Type Amount

Loss 3

Date Type Amount

Loss 4

Date Type Amount

 

VII. GENERAL INFORMATION QUESTIONS

Coverages
How Many Mortgage On Dwelling?
Is Risk located On More Than 10 Acres? Yes No
Any Business On Premises? Yes No
Has applicant had a bankruptcy in the past 5 years? Yes No
Is the property an unconventional design or construction? Yes No
Is there evidence of existing damage or disrepair? Yes No
Is the risk vacant, for sale, or in the course of new construction or reconsonstuction? Yes No
Has anyone in the household ever been convicted of insurance fraud, including arson? Yes No
Is risk a motor home, houseboat, House Trailer, or Trailerhome? Yes No
Is there a trampoline on the property? Yes No
is the named insured a corporation , including LLCs, partnerships, estates, or associations? Yes No
Does applicant own an all terrain vehicle? Yes No
Is there a swimming pool on the property? Yes No
Is the risk located on a barrier island, or on any land located south and east of the Intercoastal Waterway or over water or within 1000 feet of any coastal exposure? Yes No

Additional Remarks

Effective Date
Date Policy Will Go In Effect:

  

 

VIII. SUBMIT

How Do You Want To Be Contacted With The Quote?

NOTE: Please select one method in which you wish to be contacted, but YOU MUST ENTER A TELEPHONE NUMBER AND AN EMAIL ADDRESS.
via Telephone at this number:
via Email at this address:

 

Insurance companies  uses consumer reports to underwrite and price insurance policies.  “As part of the underwriting processing, Property Crossing orders an insurance score based upon your credit history that may be used to underwrite and price.  These consumer reports also contain information about your claim history.  You have the right to be told the name and address of the reporting agencies that provide these reports and to see and correct your personal information.  If we receive corrected personal information from a consumer-reporting agency, we will re-evaluate you.  We may disclose this information to properly service your policy or to conduct our business.  A privacy notice will be included with your policy and is available upon request.”

CLICK TO ACCEPT

Push the Submit button below and we will contact you about your quote. Thank You
 

 

 

Send mail to the  webmaster with questions or comments about this web site.
Copyright © 1997-2006 Property Crossing
Last modified July 06,  2006

Privacy Policy