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Homeowners insurance

Need a quote on homeowners insurance? Fill out the form below and receive a quote from Extraco.

* Indicates required fields.

I. Personal Information:
First Name*
Last Name*
Marital status	Single Married
If married, Name of spouse
Address to be insured*
City*
State* (Texas Only)	Texas
ZIP Code*
Home Phone*
Work Phone
Best time to reach you
E-mail*
II. House information:
Year house built
Number of stories
Total living area	sq. ft.
Number of full bathrooms
Number of half bathrooms
Number of fireplaces
III. Construction information
Type of foundation	--Select one-- Concrete slab Pier and beam
Type of construction	--Select one-- Frame Brick veneer Brick Stucco
Type of roof	--Select one-- Composition Tile Wood shingle Slate Metal
Age of roof
Type of garage	--Select one-- None Attached Detached Carport
How many cars can park in the garage?
IV. Fire protection information
Check all boxes that apply:	Central Station Fire Alarm (monitored) Central Station Burglar Alarm (monitored) Local Fire Alarm (not monitored) Local Burglar Alarm (not monitored) Fire Extinguisher Smoke alarms/detectors
Heat type	--Select one-- Central Heat and Air Space heaters Floor furnace
Approximate distance to your responding fire department	miles
Approximate distance to your nearest fire hydrant	feet
V. Miscellaneous
Do you own any animals?	Yes No
If yes, list type and Breed:
Is there a business on the premises?	Yes No
Is there a daycare on the premises?	Yes No
Is there a trampoline on the premises?	Yes No
Is there a swimming pool on the premises?	Yes No
If yes, is it fenced in?	Yes No
Is there a diving board?	Yes No
Is there a slide?	Yes No
VI. Plumbing information
Plumbing improvements	--Select one-- None Copper PVC Galvanized
Year the plumbing was updated
VII. Electrical information
Electrical improvements	--Select one-- None Fuses Circuit Breakers
Year the electricity was updated
VIII. Heat/air information
When was your current water heater and/or A/C unit installed?
IX. Insurance coverages for your quote
Amount of insurance currently on your home
Amount of personal liability
What deductibles would you like quoted? Check all boxes that apply:	$500 $1000 1/2% 1%
When does your current policy expire?
X. Optional coverages/Endorsements
Check all boxes that apply:	HO-105 Residence Glass HO-201 Personal Injury (liability protection against: libel, slander, defamation of character, etc.) HO-110 Increased limit on jewelry, watches and furs HO-210 Farmer's liability HO-2225 Additional premises (owner can include liability for other owned premises)
XI. Claim information (within the last 3 years)
Claim 1
What type of claim did you have?	--Select one-- None Weather-related Liability Theft Other
If other, please explain
Claim 2
What type of claim did you have?	--Select one-- None Weather-related Liability Theft Other
If other, please explain
Claim 3
What type of claim did you have?	--Select one-- None Weather-related Liability Theft Other
If other, please explain
Claim 4
What type of claim did you have?	--Select one-- None Weather-related Liability Theft Other
If other, please explain
	Check here for more than 4 claims
	* Enter the above characters in the space provided below.

Important Information About Procedures for Opening a New Account
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

INSURANCE PRODUCTS ARE NOT DEPOSITS, NOT INSURED BY THE FDIC OR ANY FEDERAL GOVERNMENT AGENCY, NOT GUARANTEED BY EXTRACO BANKS OR ITS AFFILIATES AND MAY GO DOWN IN VALUE. Investment consultants are registered representatives of, and securities are offered through, UVEST Financial Services, a registered broker/dealer and member FINRA, SIPC. INVESTMENT PRODUCTS ARE NOT FDIC INSURED. MAY LOSE VALUE. NO BANK GUARANTEE.