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Kentucky insurance

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Kentucky insurance
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Thoroughbred
Associates
 

E-mail: awinkie@thoroughbred
associates.com

 

Phone: 1-502-245-7841
Fax: 1-502-245-3811
Toll Free: 1-800-219-8211

Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
State: Must be Kentucky
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Is this Builder's Risk?
(new home constr.)
NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
 
Type foundation: Slab Crawlspace over slab
Basement Other (list in remarks)
 
Type Roof: Shingle Wood Shake
Tar/Gravel Metal
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
PVC
 
Circuit Breakers or fuses? Breakers Fuses
Currently Insured? Yes No
 
How is Your Credit History?
(Some carriers use credit history to qualify)
 
Prior Claims? Yes No
Describe claims in detail:

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!


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Please report site-related technical problems to: awinkie@thoroughbredassociates.com (This page last updated 01-30-03)