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Name
Spouse
Daytime Phone
Email
Your Date of Birth
Your Occupation
Spouse's Date of Birth
Spouse's Occupation
Current Address (including City, State, and ZIP)
Previous Address if Less than 5 years
Address of Property You Would Like a Quote For
Amount to be Insured
Deductibles
Current Insurance Company
Does the home have a mortgage
Yes
No
Type of Insurance Requested
Primary Residence
Tenant Property
Secondary Residence
Effective Date
Type of Construction
Brick Veneer
Vinyl Siding
Wood Siding
Masonite Siding
Hardiplank Siding
Stone Veneer
Asbestos Siding
Aluminum Siding
Steel Siding
Stucco
Mobile Home
Square Feet
Year Built
Number of Stories
Number of Bathrooms
Fireplace
Yes
No
Pool
Yes
No
If yes to pool, is it fenced?
Yes
No
Foundation
Slab
Pier & Beam
Central Heat & Air
Yes
No
If yes, is it gas or electric?
Gas
Electric
Attached Carport or Garage
1 Car
2 Car
3 Car
None
Type of Roof
Composition
Wood
Metal
Year the Roof was Installed
Do you have ATVs, Saddles & Tack, or off-road bikes? If yes, please add details
Do you have any valuable items that may need more comprehensive coverage? (i.e. jewelry, cameras, collectibles, fine arts). If yes, please add details
Mobile Home Manufacturer (If Applicable)
Length & Width of Mobile Home (If Applicable)
Is Mobile Home in a Park? (If Applicable)
Yes
No
Monitored Alarm System
Yes
No
Any Other Smart Home Features
List Any Claims
Number of Acres
Breed of dog(s), if any
Questions or Comments
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Contact Us
1711 Heritage Pkwy, Suite 200
Sherman, TX 75092
Office: 903-893-7200
Text: 903-225-8980
Fax: 903-893-7210
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Terry Jones Insurance Agency | Managed by
Olive Street Design
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