Homeowners Application | Terry Jones Agency

Get a Quote on Homeowner's Insurance

Name

Spouse

Daytime Phone

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

Type of Insurance Requested

Effective Date

Type of Construction

Square Feet

Year Built

Number of Stories

Number of Bathrooms

Fireplace

Pool

If yes to pool, is it fenced?

Foundation

Central Heat & Air

If yes, is it gas or electric?

Attached Carport or Garage

Type of Roof

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)

Monitored Alarm System

Any Other Smart Home Features

List Any Claims

Number of Acres

Breed of dog(s), if any

Questions or Comments