Georgia Home and Auto Insurance - Free Homeowners Quotes from Mortgage Brokers on GA Insurance

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770-434-6691

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5 Reasons Why You Should Use Our Insurance Services:

1. Excellent coverage at very competitive prices.

2. FAST online quotations for auto, homeowners, and life, and INSTANT quotes by phone.

3. Low down payment & Easy monthly installments on most policies.

4. Our service is second to none. Call us and get an agent who really CARES!

5. We offer a satisfaction guarantee. We know our top quality coverages and service will SATISFY you!

Remember...
"All Our Policies Come With an Agent!"

Clemmons Insurance Agencies has helped thousands of Georgia, Tennessee, South Carolina, and Missouri residents and businesses find the lowest rates available and the best insurance plans to protect their cars, homes, businesses, and families. Let us do the same for YOU! Our office includes a state-of-the-art computer system for policy services, claim servicing and accounting so that quality service is GUARANTEED. Your needs will be addressed, phone calls returned, and coverage issues responded to, and claim matters will be addressed...WITHIN 24 HOURS!

Homeowners Insurance Quotation Form For Mortgage Brokers/Real Estate Agents One Simple Form - takes only 2-3 Minutes!

Agent/Broker's Name & Company:
Agent/Broker's Phone #:
Agent/Broker's Fax #:

Your Client's Personal Data:
Your Name:
Property Address:
City:
Your "County" is?
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Home or Work Phone:
Fax or Cell # (indicate which):
Best # and Time to Contact You:


Dwelling Information

Type of Dwelling:	Home Condo Duplex Townhome

Do, or will you:	Own Home Rent Home Own AND Rent to Others

Year Home Built:

Home Square footage:

If new purchase, when is escrow closing date?

Current Home Market Value:	$

Number of units:	1 family Duplex

Type foundation:	Slab Crawlspace Pier & Post Other (list in remarks)

Type Construction:	Frame/Siding Brick/Veneer Stone Other (list in remarks)

Type Roof:	Shingle Wood Shake Tar/Gravel Spanish Tile Metal Other

Number of stories:	One 1.5 Split Level Two Three

Garage Information:	No garage 1 Car 2 Car 3 Car

Garage Type:	Built in Attached Detached

Carport?	Yes No

Does home have basement?	Yes No
List % of basement that is finished:

Do you own a dog?	Yes No
If yes, list type/for dogs, list breed:

# of feet to nearest fire hydrant:	# of miles to nearest fire station:

Name of Fire Department, if known:

Currently Insured?	Yes No
Name of Carrier & how long insured?

Prior Claims?	Yes No
List Year, and Type of claim:

Primary Policyholder's Birthdate: (Some companies products offer discounts for certain age groups.)

Spouse's Name & Birthdate: (If not married, leave blank.)


Heating Type:	Gas (Propane or natural) Electric


Central HVAC?	Yes No

Dead bolts?	Yes No

Smoke Detectors?	Yes No

Monitored Alarm System?	Yes No

Circuit Breakers or fuses?	Breakers Fuses

# Bedrooms: # of full and 1/2 Baths:

Fireplace?: Yes No Chimney? Yes No

Deck? Yes No - if yes, Size: Small Med. Large

Wood Burning Stove in Home? Yes No

Coverages:

Dwelling Cov. $ Deductible $
($250, $500, $1,000, etc.)

Select Contents Coverage: 60% of Dwelling Amt.
75% of Dwelling Amt.

Select Liability Coverage: $100,000
$300,000

Comments/Remarks
(describe any scheduled jewelry, in-home business, swimming pool, barn, or other special coverages/remarks here):

Send my quotation via: E-Mail Fax
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Thank you for filling out this form COMPLETELY!
We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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GA auto insurance

Please contact our agency at the address and phone numbers below for a free quotation today. We have the service you are looking for!
Clemmons Insurance Agencies - Smyrna, GA Office
1326 Concord Road, Smyrna, GA 30080
Phone: 770-434-6691
Fax: 770-434-6779
Email: Click Here to Email Us | Click for Map/Directions
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