Home -- Homeowner Quote

Tammy Cox Insurance Agency
18730 Stone Oak Parkway Suite 202
San Antonio, Texas 78258
(210) 402-6113
(210) 402-6279 fax

Please provide as much information as makes sense for your quote request.

Homeowner Quote Request
Closing/Renewal Date
Name
Date of Birth
SSN
Spouse Name
Spouse Date of Birth
Spouse SSN
Current Address
Phone Numbers
Information on Home Being Purchased
Address of Home to Insure
Roof Type
Use of Home?		Primary, Secondary, Rental, Vacant
Purchase Date
Purchase Price
Year Built
Exterior Construction
Square Feet
Swimming Pool?
Slide or Diving Board?
Fence around Pool?
Trampoline?
Burglar Alarm?
If yes, is it Monitored?
Dogs?
If yes, How many dogs, and what type?
Answer the following for home over 10 years old. If updates have been made, what year?
Plumbing?
Heating?
Wiring?
Age of Roof?
Loss Information Any losses on this house or any other property owned in the last three years? If so, give date, type of loss and amount of loss.
Loss Information 1
Loss Information 2
Loss Information 3
If you are currently insured, provide the following information, if known.
Carrier
Type of Policy
Policy Expiration Date
Policy Number

Tammy Cox Insurance Agency
18730 Stone Oak Parkway
Suite 202
San Antonio, TX 78258

Phone: (210) 402-6113
Fax: (210) 402-6279
E-mail: tammycox@satx.rr.com