Home Owners - Barrett Insurance Agency

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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
Month
Day
Year
How Did You Find Us*
Save More With Multi-Policy Discounts
Spouse Information (If applicable)
Spouse Name
First Middle Last
Spouse Date of Birth
MM slash DD slash YYYY

Property Address/Type
Primary or Secondary Residence*
Type of Residence
Address
Street Address Address Line 2 City State ZIP Code

Is This Insurance Policy for a New Home Purchase*
If Above Answer is "Yes", What is Your Closing Date
Month
Day
Year
If Above Answer is "No", What Year Did You Purchase It
Month
Day
Year
Purchase Price of Home
Mortgage Company of Home Being Insured
Current Insurance Company Name
Current Policy Annual Premium
Current Policy Expiration Date
Month
Day
Year
Insurance Annual Deductible Desired
Amount of Liability Coverage
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
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

Central Security Alarm
Central Fire Alarm
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
Dog Breed(s)

1.
Date of Claim
Month
Day
Year
Amount Paid
Claim Type
Description
2.
Date of Claim
Month
Day
Year
Amount Paid
Claim Type
Description
3.
Date of Claim
Month
Day
Year
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
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Contact Barrett Insurance Agency Today

1071 Rock Springs Rd

Smyrna, TN 37167

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Telephone: (615) 220-9890

Fax: (615) 220-9838

E-Mail: [email protected]

Office Hours: Monday - Friday, 8 a.m.- 5 p.m.

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