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Select Language
Afrikaans
Albanian
Arabic
Armenian
Azerbaijani
Basque
Belarusian
Bulgarian
Catalan
Chinese (Simplified)
Chinese (Traditional)
Croatian
Czech
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Dutch
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Estonian
Filipino
Finnish
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(615) 220-9890
HOME
ABOUT
CLIENT SERVICES
REQUEST A QUOTE
RESOURCES
CONTACT
Homeowners Quote
To receive your free, personalized insurance quote, simply COMPLETE and SUBMIT the following questionnaire. Information received remains confidential and used for quoting purposes only.
Step 1 of 8 - Applicant
12%
Name
*
First
Middle
Last
Email
*
Phone
*
Fax
Date of Birth
MM
DD
YYYY
How Did You Find Us
*
Search Engine
Office/Road Sign
Refferal
Advertisement
Phone Book
Direct Mail Item
Other Method
Save More With Multi-Policy Discounts
Yes, I would be interested.
No, I am not interested.
Spouse Information (If applicable)
Spouse Name
First
Middle
Last
Spouse Date of Birth
Property Address/Type
Primary or Secondary Residence
*
Primary
Secondary
Type of Residence
Single Family Home (Owner)
Duplex
Multiple Family Dwelling (More than 2 families)
Condominium (Owner)
Apartment (Renter)
Single Family Home (Renter)
Rental Property I Own
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is This Insurance Policy for a New Home Purchase
*
Yes. New Home Purchase
No. Current Residence
If Above Answer is "Yes", What is Your Closing Date
MM
DD
YYYY
If Above Answer is "No", What Year Did You Purchase It
MM
DD
YYYY
Purchase Price of Home
Mortgage Company of Home Being Insured
Current Insurance Company Name
Current Policy Annual Premium
Current Policy Expiration Date
MM
DD
YYYY
Insurance Annual Deductible Desired
Amount of Liability Coverage
$100,000
$200,000
$300,000
$500,000
$1,000,000
Flood Insurance Coverage Desired?
Yes
No
Square Footage
Please do not include basement (finished or unfinished), porch or deck square footage in the above square footage figure.
Lot/Yard Size
Year Home Was Constructed
Roof Age
Number of Bedrooms
Number of Baths
Garage Size
No Garage
1 Car
2 Car
3 Car
4+ Car
Number of Fireplaces
Deck Square Footage
Porch Square Footage
Home Type / How Many Floors
1 Story
1.5 Story
2 Story
Bi-Level
Tri-Level
Mobile Home
Type of Exterior Construction
Wood
Stucco
Masonry
Brick
Vinyl or Aluminum Siding
Type of Roof
Composite Shingle
Tin/Metal
Tile
Type of Foundation
Slab
Crawl Space
Basement (Unfinished)
Basement (Finished)
Pier and Beam
Stilt
Finished Basement Square Footage
Heat Source
Central Gas
Central Electric or Heat Pump
Propane
Heating Oil
Space Heater
Central Heating
Yes
No
Central Security Alarm
No Security Alarm
Yes, Monitored
Yes, Not Monitored
Central Fire Alarm
No Fire Alarm
Yes, Monitored
Yes, Not Monitored
Other Home Features (check all that apply)
Home Located within City Limits
Dead Bolt Locks on Exterior Doors
Smoke Detectors
Fire Extinguisher(s)
Home Located within 5 miles of Fire Station
Home Located within 1000 feet of a Fire Hydrant
Swimming Pool
Trampoline
Dog(s)
No Home Insurance Claims Filed in the Past 5 Years
Type of Pool
In-Ground (Fenced)
In-Ground (Not Fenced)
Above Ground (Fenced)
Above Ground (Not Fenced)
Dog Breed(s)
1.
Date of Claim
MM
DD
YYYY
Amount Paid
Claim Type
Description
2.
Date of Claim
MM
DD
YYYY
Amount Paid
Claim Type
Description
3.
Date of Claim
MM
DD
YYYY
Amount Paid
Claim Type
Description
Estimated Value of Your Personal Property
Jewelry and Watches
Furs
Silvers
Firearms
Stamp and Coin Collections
Fine Arts and Breakable Items
Comments/Additional Information
Captcha
E-Mail: service@barrettagency.org
Office Hours: Monday - Friday, 8 a.m.- 5 p.m.
Telephone: (615) 220-9890
Fax: (615) 220-9838