Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote.
PRIVACY PRE-NOTIFICATION:
The Howard French Insurance Agency has a privacy policy to protect and keep this information confidential and will be used for quote purposes only.
* Required fields.
Personal Information
How did you hear about us
Coverage Effective Date *
Name *
Date of Birth *
Marital Status *
Spouse's Name *
Spouse's Birth Date *
Address: *
City: *
State: *
Zip:
*
Previous Address *
City *
State: *
Zip:
Daytime Phone: *
Night Phone:*
Best Time To Call:
AM
PM
E-mail Address: *
Occupation:
How Long at Current Job:
Current
Homeowners Insurance Information
Company Name
(not agency):
Policy Expiration Date:
Years Insured:
Premium Amount:
$
House Insured For:
$
New Home Purchase *
Yes
No
Purchase Price:
$
Loan Amount:
$
Construction *
Year Built *
Square Footage *
Home Many Stories *
Foundation *
Use *
Townhome? *
Yes
No
Condo? *
Yes
No
Garage *
New Roof Year *
New HVAC Year *
New Plumbing Year *
New Electrical Year *
Realtor Name & Number *
Mortgage Person Name & Number *
Do You
Have High Value Items?
Jewelry:
$
Silver:
$
Furs:
$
Fine Arts:
$
Cameras:
$
Other:
$
Additional Comments
or Questions
Please click the "Submit Quote" button
to send your quote request. No coverage is in effect
until bound by an insurance carrier. This is a request
for quotation only.
**Privacy Policy Notification**
In order to determine
your eligibility, we are required to verify your loss history and
credit history using consumer reports. You understand and agree that
any personal information about you that you provide or that we obtain
from any consumer report may be used by any company within the
Nationwide Insurance group of insurance companies to issue, review
and renew the insurance for which you are applying. You have the
right to access and correct all personal information collected.
If you do not want us
to order a credit and claims report, we can still provide you with a
conditional quote; however without these reports, the quote may be
rather inaccurate and cannot be used as final rates for your
mortgage company or budgetary purposes.
The Howard French Insurance Agency
5541 Cabat Lake Court
Fairfax, Virginia 22032
703-738-4800 office | 703-738-4488 fax
8220 Jones Road, Suite
100
Houston, Texas 77065 281-677-9491 office | 281-677-9492 fax
