Homeowners Insurance Quote

Safeguarding Your Future with S. Galloway Agency, Inc.

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HOMEOWNER'S QUOTE QUESTIONNAIRE

Primary Full Name

Date of Birth

Phone

Address of Property

Previous Address (if above address less than two years)

Secondary name on loan (if applicable)

Date of Birth

Phone

Previous Address (if above address less than two years)

Is this a new purchase?

If no, who is your current carrier?

Renewal date?

Number of household residents?

Age of roof?

Age of water heater?

Swimming pool/Trampoline?

Animal with a bite history?

Has home undergone a complete overhaul? (Specifically electrical and plumbing)

If yes, when?

Any home claims for any resident within 5 years?

If yes, please list the dates and the type of claim (water, wind, fire, etc.)

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CONTACT DETAILS

S. Galloway Agency, Inc.

Office: 507 N. Sam Houston Pkwy E. Ste. 505

Houston TX 77060

Phone Number: 281-886-7125

Email: info@insuredwithserena.com

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