James H. Fox Insurance

Home
Homeowners Insurance Quote Form
For the fastest and most accurate homeowners insurance quote, please provide as much information possible in the form below. This information will be kept confidential and will be used for quote purposes ONLY!

General Information
Name:
Address:
City:   State:   ZIP:
County:   Email:
Phone Day: ( ) -            Night: ( ) -
Best time to call:   am  pm
Occupation:         How long at current job: years   months

Current Homeowners Insurance Company (not agency):
Company Name:
Policy Exp. Date: / /
Amount Insured For: $
Premium: $
Term: 6 Months   1 Year   Other  

Home Information
How long at present address: years months Year home was built:
       
      Sq. footage of home (excluding garage and basement):
       
Please list any claims (below) in last 5 years:
Date of Claim
Claim Description
Amount Paid
$
$
$
$
$

Structure Information
Type: Construction: Roof: Foundation: Garage:
  Age of roof:   yrs.  

Exterior Wall Type
(enter percentage of each):		 Stucco: %     Wood Siding: %     Brick: %

Features
Bathrooms: Basement: Deck/Porch/Patio: Fireplaces:
  # of Full:  
  # of Half:  
Sq. Ft: 		Deck Sq. Ft:  
Porch Sq. Ft:  
  Screened Patio Sq. Ft:   		 # of Chimneys:  
 # of Hearths:  

Interior Flooring
(enter percentage of each):
Carpeting: %
Linoleum: %		       Ceramic Tile: %
Hardwood: %

Additional Features
Heating System: Central Air: Central Vac: Security Alarm: Fire Alarm: Smoke Detector:
yes
no 		 yes
no 		 yes
no 

 Swimming Pool:      Spa:      Number of Dogs:  Type (Breed) of Dogs:
yes
no 		 yes
no 

Additional Comments:
Please give any additional comments about the coverage you desire:

 

Thank you for your time in submitting this homeowners quote form. One of our representatives will respond to your submission as soon as possible!