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HRS Insurance Agency
1401 Malvern Avenue Suite 30
Hot Springs, AR  71913
501-547-2107

 

Current Policy Information

Current Insurance Company:
Policy Expiration Date:

Home Value to be Covered:


OR Renter's Contents:



Deductible:
($1000, Other)
Liability Coverage:
($100,000, $300,000, Other)
Current Annual Premium:
# of Claims in Last 3 Years:

 

Property Information

Is Location to be Insured Same as Above: No   Yes
If 'No' Above, Please Complete Location Information:

City:  State:   Zip:
Ownership: Own   Rent
Property Is A: Home   Condominium* Townhouse Apartment
* If Condo - Number of Units in the Building
How Long at Present Address: Years Year Home Was Built
Age of:
(years)
Roof
Wiring
Heat
Plumbing
Fire Department Name:

Miles From Dwelling:

Nearest Fire Hydrant:



Miles

Feet

 

Structure Information

Type
Construction
Roof
Foundation
Garage
Sq. Ft.:
(excluding basement & garage)
 
 
 

 

Features

Bathrooms
Basement
Deck/Porch/Patio
Fireplaces
# of Full:
# of Half:

Sq. Ft.:
Deck Sq. Ft.:
Porch Sq. Ft.:
Screened Patio Sq. Ft.:
# of Chimneys:
# of Fireplaces:
Woodburning Stove:
No Yes
Swimming Pool Trampoline Pets Scheduled Property

No   Yes

# of Pets:
Claims?:
Personal:
Computer:
Office Equip
:

 

Security/Systems

Heating System
Central Air
Dead Bolts
Security Alarm
Fire Alarm
Smoke Detector
No
Yes
No
Yes

Extinguishers?
No Yes

No
Yes

 

Additional Considerations/Requests

Please give any additional comments you feel appropriate for this quotation.


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