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Frees Insurance prides itself on getting to know our clients to determine with which company 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.

Name*
First Last
Email*
Phone*
Insured Location Address*
Street Address Address Line 2 City State ZIP Code
Desired Policy Effective Date
MM slash DD slash YYYY
Date of Birth*
MM slash DD slash YYYY
Policy Type*
Is this a homeowners, condominium, or renters policy?
- Homeowners
- Condominium
- Renters
Is this a new purchase?*
- Yes
- No
Is this a new lease?*
- Yes
- No
Settlement Date
MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State ZIP Code
Personal Liability
This pays if you or another household resident injures someone or damages their property
Dwelling Coverage
This protects the structure and anything permanently attached.
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 to Others
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
In the event of a loss, this is the amount you are required to pay before the insurance company will pay on your behalf.
Additional Endorsements
- ID Theft
- Loss Assessment
- Personal Injury
- Earthquake
- Back Up of Water and Sewer
- Sinkhole Collapse
- Power Surge (Special Personal Property)
In-Home Business
Do you conduct business at home? (i.e. hair salon, consulting, etc.)
- Yes
- No
Decriptions
Valuable Items
Do you have any valuable items? This may include jewelry, furs, computers, etc.
- Yes
- No
Decriptions
Dogs in Household*
Do you own any dogs?
- Yes
- No
Dog Breed*
Please list dog breed(s).
Year Roof Replaced*
Home Heating Type*
- Oil
- Gas
- Electric
Finished Basement?*
- Yes
- Partial
- No
Additional Comments
Anything else we should know?
One Last Thing!
How did you hear about Frees Insurance?
Please Explain

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120 Gay Street
PO Box 289
Phoenixville, PA 19460

610-933-4950
info@freesinsurance.com

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M-F:: 8:00am - 4:00pm

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