The Rainville Agency - Fredericksburg Virginia

The Rainville Agency - 4034 B Plank Road - Fredericksburg, VA

Homeowner's Quote Form

Personal Information

* required field

* Name:

* Address:

* City:

* State:

* Zip code:

* Phone:

Fax:

* E-mail:

Previous Address

If you've been at your current address for less than three years
please include your previous address

Previous Address:

City:

State:

Zip code:

Current Dwelling

* Year Built:

* Distance from hydrant:

* Distance from Fire Dept:

* Structure:

* Swimming Pool:

Fence Around Pool:

* Deductible Requested:

* Monitored Alarm:

* Smoke Detectors:

* Current Insurer:

* Has any company declined, cancelled, or refused to renew similar insurance (non-pay cancellation or previous carrier request that coverage be purchased from another company is the same as being cancelled or declined)?

Any claims filed in the past 5 years:

* Any Dogs:

Breed:

Unusual Pets:

Farming Exposure:

Any Valuables over $3,000:

Guns	dollar amount
Jewelry	dollar amount
Furs	dollar amount

List of Improvements

	Dates
Roof:
Electric:		Amps
Heating:

* Flood Insurance is

Comments:

You may recieve a multi-policy discount by purchasing both a homeowners policy and an auto policy. Are you interested in receiving a quote for an auto policy as well?

In order to accurately quote your insurance, it is necessary for us to acquire a credit score. By submitting this form, you are giving us permission to obtain this brief overview of your credit history.

Remember! Completion of this form constitutes a request for a quotation. It is not intended to replace or act as an actual insurance contract or binder.

This web page may contain information that is legally protected.
While all attempts are made to protect the user's confidentiality, the Internet is not 100% secure.
Some links are to pages outside the control of this agency, and the agency can not assume liability for content outside of it's control.

Another quality website proudly designed,
promoted and maintained by

Simply Web Services of Fredericksburg, Virginia

© Simply Web Services & The Rainville Agency
Page created May 20, 2006
Today is Thursday, 03-Jul-2008 19:15:33 EDT
Page last updated Thursday, 03-Jan-2008 17:08:46 EST
http://www.we-insure-you.com/homeowner_insurance.html