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Get a Quote

Home & Auto

Frees Insurance prides itself on getting to know our clients to determine with which carrier they fit best. To that end, we will use the information provided below to help us better understand your needs before quoting. Once your quote request is submitted, we will contact you to discuss coverage options. Please allow one business day for response.

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Step 1 of 5

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Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

What type of Insurance are you looking for?*

Home

Auto

Umbrella

Desired Effective Date

MM slash DD slash YYYY

Prior Insurance

Please tell us if you currently have auto insurance.

Yes

No

Prior Insurance

Please list prior insurance company and effective dates.

Prior Insurance

If available, please upload a copy of your current declarations page.

Drop files here or

Accepted file types: pdf, png, jpg, , Max. file size: 2 GB, Max. files: 4.

List All Household Drivers*

Driver Full Name

Date of Birth (MM/DD/YYYY)

License Number

List All Vehicles*

Year

Make & Model

VIN

Collision Deductible*

Collision coverage pays to repair your car in the event you are responsible for the damage or involved in a hit and run. This is the amount you are responsible for paying before the insurance company pays.

Comprehensive Deductible*

Comprehensive (other than collision) coverage pays for losses to your car that are not due to a collision, such as theft, vandalism, glass breakage, hitting a deer, etc. This is the amount you are responsible for paying before the insurance company pays.

Roadside Assistance*

Roadside Assistance will provide towing service as well as roadside services such as a jump start, fuel delivery, flat tire change and lockout assistance.

Yes

No

Rental Reimbursement*

Rental Reimbursement pays for you to rent a car if your car is off the road due to a covered loss. Per day / Per occurrence.

Bodily Injury and Property Damage*

Bodily injury pays in the event you injure others in an accident and also provides for a legal defense if you are sued. Property damage pays for the damage you've caused to someone else's property.

Uninsured and Underinsured Motorist*

Uninsured motorist coverage protects you in in the event you are injured by someone without any liability coverage. Underinsured motorist coverage protects you if they do not have sufficient coverage.

Stacking Option*

Stacking your Uninsured and Underinsured Motorist coverages multiplies the coverage limit by the number of vehicles on the policy.

Yes

No

Tort Option*

Full tort allows you to sue for monetary and non-monetary damages as a result of any accident. Limited tort means that you cannot sue for non-monetary damages (pain and suffering) unless you were seriously injured.

Full Tort

Limited Tort

Medical Coverage*

This covers medical expenses you may need to treat injuries resulting from an accident involving a vehicle.

Wage Loss*

This coverage pays your lost wages in the event you are unable to work due to injuries sustained in an auto accident. Per month / Per Occurrence

Funeral Benefit*

This helps cover funeral costs in the event of death from an auto accident.

Accidental Death*

This pays in the event of a fatal accident.

Prior Accidents & Violations*

Ride-Sharing & Delivery*

Do you currently drive or intend to drive for Uber, Lyft, Grubhub, or other delivery services?

Yes

No

Billing

How do you intend to pay your auto insurance?

Desired Policy Effective Date

MM slash DD slash YYYY

Date of Birth

MM slash DD slash YYYY

Policy Type*

Homeowners

Condominium

Renters

Is this a new purchase?*

Yes

No

New Address

Street Address Address Line 2 City State ZIP Code

Prior Insurance*

Please tell us if you currently have homeowners or renters insurance.

Yes

No

Prior Insurance

Please list prior insurance company and effective dates.

Prior Insurance

If available, please upload a copy of your current declarations page.

Drop files here or

Accepted file types: pdf, png, jpg, Max. file size: 2 GB, Max. files: 4.

Personal Liability

This pays if you or another household resident injures someone or damages their property

Personal Property*

This coverage pays to replace your wardrobe, electronics, furniture, and all other belongings. Let us know if you need assistance estimating the total value of your belongings.

Medical Payments

This is a good will offering in the event you are involved with someone, other than an insured, being injured. It will pay their related medical bills.

Deductible

This is a good will offering in the event you are involved with someone, other than an insured, being injured. It will pay their related medical bills.

Additional Endorsements

Power Surge (Special Personal Property)

ID Theft

Back Up of Water and Sewer

Buried Utility Line

Roof & Siding Match

Personal Injury

Loss Assessment

Earthquake

Sinkhole Collapse

Valuable Items*

Do you have any valuable items you want to insure? This may include jewelry, furs, computers, etc.

Yes

No

Valuable Items*

In-Home Business*

Do you conduct business at home? (i.e. hair salon, consulting, etc.)

Yes

No

In-Home Business*

Dogs In Household*

Do you own any dogs?

Yes

No

Dogs In Household*

Please list breed(s)

Year Roof Replaced*

Heating Type*

Finished Basement?*

Additional Comments

Umbrella Liability Amount*

Umbrellas can be purchased in million dollar increments.

Additional Exposures

One Last Thing!

How did you hear about Frees Insurance?

Friend or Family

Please list his/her name so that we can thank them for the referral!

Please Explain

How did you hear about Frees Insurance?

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Email

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120 Gay Street
PO Box 289
Phoenixville, PA 1960

(610)933-4950
info@freesinsurance.com

Hours:
M-F: 8:00am -4:00pm
Appointments by Request

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