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The Host Insurance group guarantees your satisfaction!

Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
Your "County" is?
State: (Must be Texas)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
Primary Insured's Occupation:
 
Primary Policyholder's Birthdate:
(REQUIRED - Some companies products
offer discounts for certain age groups.)
 
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Is this Builder's Risk?
(new home constr.)
NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
 
Type foundation: Basement
Slab
Crawlspace over slab
Other (list in remarks)
(If basement, what % is finished?)
% FINISHED
 
Type Construction: Frame
Brick/Veneer
Stone
Other (list in remarks)
 
Type Roof: Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Does Home Have a Garage? Yes No
Tell whether built in, detached/attached, and how many cars?
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Rate Your Credit History and Past Insurance Payment History:
(Some companies products are
based on your credit and payment history.)
Excellent Fair
Poor Horrible
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
 
Heating Type: Gas (Propane or natural)
Electric
Oil (if oil, list tank location in remarks)
 
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Texas insurance quotes
The Host Insurance Group | Email: insservice@pdq.net
Toll Free Phone: 866-683-3535 | Local Phone: 281-342-3276 | FAx: 281-342-3513
201 Jackson Street | Richmond, TX 77469 |Terms of Use/Privacy Notice | (This page last updated June 2011)
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Design 2011 Insurance-Web-Sales
Texas insurance quotes

The Host Insurance Agency offers A rated insurance from a variety of providers to ensure the best rates with
the best coverages. We offer fast, friendly and hassle-free service. Call us today for your quote on renters,
flood, condo, homeowners, auto, commercial, workers compensation, medical and life insurance needs.

Areas we service include these Texas cities: Abilene, Alvin, Amarillo, Angleton, Arlington, Atascocita, Austin, Bay City,
Baytown, Beaumont, Brenham, Bryan, Channelview, College Station, Conroe, Corpus Christi, Dallas, Denton, El Paso, Fort Worth,
Friendswood, Galveston, Houston, Humble, Huntsville, Katy, Kerrville, Lake Jackson, Longview, Lubbock, Missouri City, New Braunfels,
Pasadena, Pearland, Richmond, Rosenberg, San Antonio, Seguin, Spring, Sugar Land, Temple, The Woodlands, Tyler, Uvalde, Victoria, Waco.