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
Full Name: *
Address: *
City: *
State: *
Zip:
*
Daytime Phone: *
Night Phone: *
Best Time To Call:
AM PM
E-mail Address: *
Current Auto Insurance Information
Company Name: (not agency)
Policy Expiration Date:
Premium Amount: $
Policy Term:
6 Months 1 Year
Years Insured:
Vehicle Information (All cars you or your family members own or lease)
*
Car #1
Year
Make
Model
Body Type
Car #2
Year
Make
Model
Body Type
Car #3
Year
Make
Model
Body Type
Car #4
Year
Make
Model
Body Type
Liability Limit For ALL Cars
Choose either:
Bodily Injury and Property Damage
Bodily Injury
Property Damage
OR Single
Limit
Single Limit
Deductibles
Comprehensive Deductible
Collision
Deductible
Towing
Rental
Reimbursement
Car #1
Yes
Yes
Car #2
Yes
Yes
Car #3
Yes
Yes
Car #4
Yes
Yes
Excess
Liability
Personal
Umbrella Coverage:
Yes
No
Amount:
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
