Visit our office at608 Stine Lane in Jenningsor call us at (337) 824-4455
Homeowners Insurance Quotation
from Jeff Davis Insurance Agency
Please complete this one pageHomeowners Insurance Quotation Request Form.Click here for Frequently asked Questions
Name
Address
City
State
Louisiana
Zip Code
E-Mail Address
Phone Number
Date of Birth
Social Security #
Spouse's Name
Spouse's Date of Birth
Spouse's Social Security #
Current Home Insurance Company
Date Policy Expires
Amount Home Insured For
If Home is a New Purchase Give Date of Closing
Is there an Appraisal
Yes
No
If Yes, How muchis the Appraisal for?
How is Homeowner's Insurance Paid
Escrowed
Insured Billed
Home is a
Single Family
2-4 plex
Occupation
How Long at Current Job
How Long at Current Address
Number of Claimsin Last 3 Years
Square Footage of Home(not including garage, carport or basement)
Year Home Was Built
If over 25 years old, when was thelast time the following were updated:
Roof
Approximate Year
Wiring
Plumbing
Heating
Number of Floors
Type Construction
Foundation
Roof Style
Garage Size
Garage Style
