* Required field

Name* Phone
Email Address*
Single/Married Date of Birth Spouse Age
Occupation Spouse Occupation
Location of house to be Insured
Year House was Built Value of House
Type Construction:
Brick
Vinyl Siding
Built on Slab? Elevated?
If yes, how high?
Square Footage Number of Stories Deductible
Garage/Carport If garage, how many car spaces?
What type of heating system? Electric/Gas Central
Space Heaters? Smoke Detectors? Fire Alarm?
Burglar Alarm? If yes, is it monitored?
Is there a swimming pool on the premises? Trampoline
Are you in a Flood Zone? If yes What Zone?
Do you own a boat? Do you have any pets?
If so kind?
Do you own any secondary or rental homes?
Liability Limit Medical Payment Limit
Previous Insurance Carrier Exp. Date
Any claims and/or losses incurred within the past 5 years?
If yes, give dates and types of losses:
Have you ever claimed a Bankruptcy, Tax Lien, Foreclosure of Judgment?
Have you been cancelled or non-renewed by any Insurance Co?
If so explain
Is there a closing on this house?
If yes, when Closing attorney's name
 
 

Personal

We customize plans to provide an umbrella of protection for you and your family.

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Business

We offer a variety of business products and services to provide the protection you need.

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Agriculture

We recognize the agricultural industry requires specialized coverage and personal account attention.

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Call Us At

for more information or a free quote

1803 King Road
Tifton, GA 31794
Phone: (229) 382-3396
Toll Free: (800) 810-8699
Fax: (229) 387-9200