Laura Harris Agency Inc.
Professional Service
 
5350 S Staples St Suite 150
Corpus Christi, TX 78411
361-985-2875
361-985-0509 (fax)
E-mail:dawneperez@allstate.com

Our agency is licensed to quote and write insurance policies only in Texas. To find agents offering these coverages in all other states, please click the IQ.net logo.

  

 

Homeowner/Condo/Tenant Insurance Quote

Completely fill out and submit this form to our agency to receive an accurate quote. You MUST provide at least one method of contact to receive a quote from our agency.



 Name: (required)  
 E-Mail Address: (required)  
 Street:  
 City: (required)  
 County:  
 State:(required)   Zip: (required)
 Day Phone:  
 Evening Phone:  
 FAX:  
   
Social Security #  
In order to provide a PREFERRED policy quote some of the companies that we represent may require a credit history. For Preferred quotes, Social Security numbers are required. You do not have to provide social security numbers at this time but we can't guarantee that we can provide the best price available until after we speak with you and secure this credit information.
 Check this box to grant our agency permission to secure your credit history, for insurance purposes only, under the Fair Credit Reporting Act. Your name

Current Homeowner Coverages
 Dwelling Amount (required)    
 Personal Property (contents), Outbuilding Coverage, Additional Living Expenses are calculated from the dwelling amount.
 Property Coverage Deductible    
 Comprehensive Liability Amount    
 Medical Payments    
 Guaranteed Replacement Cost Coverage    
 Water Backup Coverage    
 Earthquake Coverage    
     

Tell us about your home:
 Construction  
 Type Of Home  

Number of Stories 

  

 Ground floor square footage  

  

 Total basement area (sq ftt) 

  

 Condo Owners or Renters Only - Personal Property Amt

  
 Year home built  
 Distance to nearest fire hydrant  
 Distance to nearest fire station  
Inside or Outside of City?

If outside. How many miles?
  Type of Alarm  
   Sprinklers?  

Type of Roof

 Any business conducted on premises?

   Type of business  

 Any animals?

  

 Breed & Weight

  

 Any losses past 3years? Please describe what type of loss and dollar amount of loss
       



The following is optional information, but by providing it we are able to give you a more accurate quotation.
 Shape of house (# of corners)  
 3 Wall Addition? (square feet)  
 Percent of basement finished  
 Attached Garage  
 
Number of Bathrooms		  
 Family Room  
 Sun Room  
 Den  
 Number of Fireplaces  
 Separate Dining Room  
 Any hardwood Floors  
 Central Air Conditioning  
 Decks ( total square feet)  
 Porches (total square feet)  
 Large Laundry Room  
 Large foyer  
 Central Vac  
 Video entry system  
 Sauna  
 Hot tub  
 Jaquzzi bath  
 Dishwasher  
 Trash Compactor  
 Range hood  
 Garbage disposal  
 Any aditional information that you might feel is important in quoting your home insurance  
   




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Page Created 4-29-02
 
 
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