Full Name:          
Address to be Insured:
City:
Texas
Zip Code:
Email: (Required) 
Home Phone:   Work Phone:   Ext.
How to Contact You:       Cell Phone:
Date of Birth:              (mm/dd/yyyy)
Social Security #:       

Spouse Name:             
Date of Birth:              (mm/dd/yyyy)
Social Security #:       

Do you currently have Texas Flood Insurance?
Do you currently have TX Homeowners Insurance?
Current Insurance Company: 
Expiration Date: (mm/dd/yyyy)

Coverage requested for?
Usage Type:
Years Lived at Address to be Insured:  

Texas Homeowners Insurance Coverages & Limits of Liability:

Dwelling ($ value):
Additional Structures ($ value):
Personal Property ($ value):    

Personal Liability (each occurence):
Medical Payments (each person):   
Other Perils Deductible:
Windstorm Deductible:

Policy Endorsements:

Replacement Cost, Dwelling: Yes No
Replacement Cost, Contents: Yes No

Texas Homeowners Insurance - Dwelling Information:

Building Structure:
Year Dwelling Built:     Dwelling Square Feet:
Smoke Detectors?             Deadbolt Locks?    
Central Burglar Alarm?      Central Fire Alarm?
Sprinklered All Rooms?
Primary Heat Type:
Do you have a Wood Stove? If yes, is it on a separate flue?

Fireplace: 
Full Baths:     Half Baths:   
Garage:         Garage Size:
Basement:

Type of Wiring:         
Wiring Renovation:         Wiring Renovation Year:   
Plumbing Renovation:     Plumbing Renovation Year:
Heating Renovation:       Heating Renovation Year:  
Roofing Renovation:       Roofing Renovation Year:  
Roof Type:     Roof Age (years):
Exterior Paint Renovation:     Exterior Paint Renovation Year:

Dwelling Distance from Fire Department:  miles
Dwelling Occupied By:
Swimming Pool:              Diving Board:  
Pool Screened:               Approved Fence:  

Loss History:

Did you have any losses, whether or not paid by insurance, during
the last 3 years, at this dwelling location or any other location?
If the answer to the previous question was "Yes", please explain below.

Date                            Type           Explanation of Loss           Loss Amount
      
      
      

Additional Information:


Click on the "Submit Quote Request" button below to send
your Texas Homeowners Insurance quote request.**


**Information received from this Texas Homeowners Insurance quote request form
sent to Texans Insurance & Financial Group will be for our use only and will not be
sold, given to or distributed to any other parties. A quote will be based on the Texas
homeowners insurance policy information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to
meeting underwriting guidelines, and the terms, conditions and exclusions of
the policy as issued. By submitting this request you acknowledge that this is
neither an offer to insure nor a guarantee of insurance. Completion of this
form does not entitle you to a Texas Homeowners Insurance policy. We are
licensed in Texas will not provide homeowners quotes for other states.


Texas
Homeowners
Insurance Quote
We can provide lower cost Texas Homeowners Insurance
coverage in Fort Bend County and throughout Texas!
Texans Insurance &
Financial Group of
Sugar Land, TX offers
affordable and
experienced personal
insurance coverage
services throughout
Texas.
Contact us about Texas
Auto, Renters, Health,
Homeowners, Boat,
Motorcycle, RV, and
Flood Insurance toll free
at 800-747-6140.
In addition to Texas
Homeowners
Insurance, we also
offer affordable Auto
Insurance policy
premiums.
We are a Sugar Land, TX insurance agency offering affordable Texas
homeowners insurance quotes in the following towns, cities and counties
in southeast Texas: Meadows, Town West, Four Corners, Crabb, Booth,
Thompsons, Fresno, Manvel, Pleak, Kendleton, Eagle Lake, Sandy
Point, Beasley, Rosenberg, Richmond, Orchard, Fulshear, Juliff, Arcola,
Needville, Frydek, Rosharon, Bonney, East Bernard, Lissie, Elm Grove,
Spanish Camp, Wharton, Guy, Bellville, Wallis, Pasadena, Deer Park,
Houston, Pearland, Galena Park, Jacinto City, La Porte, Bellaire, West
University Place, Cloverleaf, Beaumont Place, Spring Valley, South
Houston, Iowa Colony, Hilshire Village, Humble, Houmont Park,
Friendswood, League City, Alvin, Mission Bend, Stafford, Missouri City,
Texas City, Webster, Dickinson, Baytown, Channelview, Highlands,
Seabrook, Bacliff, La Marque, Jersey Village, Lake Jackson, Surfside
Beach, Algoa, Santa Fe, Barker, Katy, Sealy, Dayton, Angleton,
Freeport, Bammel, Kohrville, Bay City, Brenham, Addicks, Brookshire,
San Felipe, Hockley, Waller, Prairie View, New Caney, Beach City,
Nassau Bay, North Houston, Hempstead, Tomball, The Woodlands, Burr,
Iago, Boling, Peters, Cat Spring, Burleigh, Waller County, Wharton
County, Brazoria County, Harris County, and Fort Bend County, TX. We
can also offer lower cost Texas homeowners insurance policy rate quotes
throughout the Lone Star state, including in Beaumont, Austin, Waco,
Fort Worth, Dallas, and San Antonio, TX.

Applicant Information
Texans Insurance
& Financial Group
101 Southwestern Blvd.
Suite 230
Sugar Land, Texas 77478
Fort Bend County, TX
Office: (281) 277-7800
Toll Free: (800) 747-6140
Fax: (281) 277-7801

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