Home Insurance Austin Texas "Save money on insurance! We represent a statewide network of Texas insurance companies!"									Austin Insurance Group Contact Us: aig@texas.net

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To get a Free, No-Obligation Texas auto or Texas home insurance quote, complete the form below.

auto insurance quote texas

Name:

Phone # (including area code):

Fax # (including area code):

Email:

Street Address:

City:
State:
ZipCode where Vehicle(s) Parked:
County:

Driver 1 - Date of Birth:
For the most accurate quote, please provide your social security number:
Male   Female
Married   Single
Total years licensed in U.S.:
Driver 1: List all.. ...Tickets, Accidents, and Claims over the past 3 years by date and type:

Driver 2 - Date of Birth:
Male   Female
Married   Single
Total years licensed in U.S.:
Driver 2: List all.. ...Tickets, Accidents, and Claims over the past 3 years by date and type:

Driver 3 - Date of Birth:
Male   Female
Married   Single
Total years licensed in U.S.:
Driver 3: List all.. ...Tickets, Accidents, and Claims over the past 3 years by date and type:

Driver 4 - Date of Birth:
Male   Female
Married   Single
Total years licensed in U.S.:
Driver 4: List all.. ...Tickets, Accidents, and Claims over the past 3 years by date and type:

Does any driver require an SR22 filing? Yes    No
If yes, on which driver and what is it for?

Do you own the home that you live in? If yes, you may be eligible for an additional discount.
Please check if applicable:
House   Mobile Home
Condo   Duplex

Do you have 6 months Continuous Insurance? Yes   No
If yes, who is your current carrier?

Vehicle 1 Year/Make/Model:

2 Door    4 Door    Van    Truck
Vin #:

Vehicle 2 Year/Make/Model:

2 Door    4 Door    Van    Truck
Vin #:

Vehicle 3 Year/Make/Model:

2 Door    4 Door    Van    Truck
Vin #:

Vehicle 4 Year/Make/Model:

2 Door    4 Door    Van    Truck
Vin #:

Vehicle 5 Year/Make/Model:

2 Door    4 Door    Van    Truck
Vin #:

Please check liability limits desired?
20/40/15   25/50/25
50/100/50   100/300/100

For additional coverage, check all that apply:
Uninsured Motorist
Medical or PIP

List Comprehensive Deductible Desired for each vehicle:
$50 $100 $250 $500 $1000
Vehicle 1   Vehicle 2
Vehicle 3   Vehicle 4
Vehicle 5

List Collision Deductible Desired for each vehicle:
$100 $250 $500 $1000
Vehicle 1   Vehicle 2
Vehicle 3   Vehicle 4
Vehicle 5

Towing
Rental

Additional Comments:

texas homeowners insurance quote
renters insurance

Do you want a Homeowner's or Renter's quote?
(Please check one)
Homeowner   Renter   Flood Insurance

Name:

Date of Birth:
For the most accurate quote, please provide your social security number:
Phone # (including area code):

Fax # (including area code):

Email:

Street Address:

City:
State:
Zip Code:
County:

What type of home do you live in?
House   Mobile Home
Condo   Duplex
Apartment
Other (please list what type in comments section)

Construction - More than 51%...
Frame   Brick/Rock   Stucco

Check which foundation applies?
Slab   Pier & Beam   Elevated

Monitored Burglar Alarm? Yes    No

Inside City Limits? Yes    No

How far is the nearest fire hydrant (in feet)?

How far is the nearest fire station (in miles)?

Do You Own a Dog? Yes    No
If yes, what type(s)?:

Do You Have a Pool? Yes    No
If yes, is it fenced in?: Yes    No

Do You Do Business Out of Your Home?
Yes    No    If yes, what kind?:

List all claims (type and date and amount paid out) in the past 10 years:

Current Insurance Company (if applicable):

What is the expiration date of your current policy?

HOMEOWNERS:
a. What is the value of your Home?
b. What is the square footage?
c. What year was your home built?
If over 30 years old, when was the plumbing and electrical updated?

d. How many stories does it have?
e. Age and Type of Roof
(ie. composition shingle, wood, tile, etc.)?
f. Deductible Desired? $250    $500    $1000    1/2%    1%    2%
g. Is this a new purchase? Yes    No

RENTERS:
a. What is the value of your Personal Property?
b. What year was your property built?

Please feel free to comment about your specific needs and questions:

Please note that no coverage can be bound, modified, or cancelled by email, phone or fax.
Original signatures are required on applications and other forms as appropriate.

For a quick quote (choose one): auto . motorcycle . homeowners . mortgage protection . renters insurance . boat . Texas life . annuities . disability . health insurance . dental . umbrellas . commercial . business Auto . workers comp
e-mail: aig@texas.net, call 800.929.3166 or fax 512.339.0169 for a FREE QUOTE today!

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