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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Desired Policy Effective Date Date Format: MM slash DD slash YYYY Date of Birth* Date Format: MM slash DD slash YYYY Policy Type*Is this a homeowners, condominium, or renters policy?HomeownersCondominiumRentersIs this a new purchase?*YesNoIs this a new lease?*YesNoSettlement Date Date Format: MM slash DD slash YYYY Current Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Personal LiabilityThis pays if you or another household resident injures someone or damages their propertyPlease Select$300,000$500,000Dwelling CoverageThis protects the structure and anything permanently attached. Personal PropertyThis 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 OthersThis 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.Please Select$1,000$5,000$10,000DeductibleIn the event of a loss, this is the amount you are required to pay before the insurance company will pay on your behalf. Please Select$500$1,000$2,500$5,000Additional Endorsements ID Theft Loss Assessment Personal Injury Earthquake Back Up of Water and Sewer Sinkhole Collapse Power Surge (Special Personal Property) In-Home BusinessDo you conduct business at home? (i.e. hair salon, consulting, etc.)YesNoDecriptionsValuable ItemsDo you have any valuable items? This may include jewelry, furs, computers, etc.YesNoDecriptionsDogs in Household*Do you own any dogs?YesNoDog Breed*Please list dog breed(s).Year Roof Replaced*Home Heating Type*OilGasElectricFinished Basement?*YesPartialNoAdditional CommentsAnything else we should know?One Last Thing!How did you hear about Frees Insurance?Please SelectGoogleSocial MediaReferred by Friend or FamilyOtherPlease Explain
