low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
  Return to Home Page
Visit Our Agency's
Low Cost Missouri
Insurance Resources
Personal Lines
low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
Commercial Lines
  Our Other Services
low cost missouri personal and business insurance from Whitney Harrison Insurance Agency
  • Service My Account
  • Company Service Sites
  • About Our Agency
  • Office Directions/Map
  • Our Privacy Statement

    E-Mail Us:
    email Whitney Harrison insurance
    larryb@whitneyharrison.com
    Whitney Harrison
    Insurance, Inc.
    2412 S. Franklin
    Kirksville, MO 63051

    Toll Free: 800-748-7185
    Local Phone: 660-665-1212
    Fax: 660-665-9444

    Whitney Harrison insurance guarantees your Missouri insurance satisfaction!
    		•     

    Homeowners Insurance
    Quotation Form
    One Simple Form - takes only 2-3 Minutes!
    Your Personal Data:
     
    Your Name:
    Property Address:
    City:
    Your "County" is?
    State: (Must be Missouri)
    Zip/Postal:
    E-Mail (REQUIRED):
    E-Mail again for accuracy:
    Phone:
    Fax (optional):
    Primary Insured's Occupation:
     
    Primary Policyholder's Birthdate:
    (REQUIRED - Some companies products
    offer discounts for certain age groups.)
     
     
    Dwelling Information
     
    Year Home Built:
    Home Square footage:
     
    Is this Builder's Risk?
    (new home constr.)         		NO YES
     
    Month/Year home
    to be complete:
     
    Number of units: 1 family Duplex
     
    Type foundation: Basement
    Slab
    Crawlspace over slab
    Other (list in remarks)
    (If basement, what % is finished?)
    % FINISHED
     
    Type Construction: Frame
    Brick/Veneer
    Stone
    Other (list in remarks)
     
    Type Roof: Shingle
    Wood Shake
    Tar/Gravel
    Spanish Tile
    Metal Other
     
    Number of stories: One 1.5
    Two Three
     
    Do you own animals or pets? Yes No
    If yes, list type/for dogs, list breed:
     
    Are You Near Brush Area? Yes No
     
    # of feet to nearest
    fire hydrant:     		# of miles to nearest
    fire station:
     
    Does Home Have a Garage? Yes No
    Tell whether built in, detached/attached, and how many cars?
     
    Currently Insured? Yes No
    Name of Carrier & how long insured?
     
    Prior Claims? Yes No
    Describe claims in detail:
     
    Rate Your Credit History and Past Insurance Payment History:
    (Some companies products are
    based on your credit and payment history.)     		Excellent Fair
    Poor Horrible
     
    Plumbing type: Copper Galvanized
    Mixed (Copper/Galvanized)
     
     
    Heating Type: Gas (Propane or natural)
    Electric
    Oil (if oil, list tank location in remarks)
     
    Circuit Breakers or fuses? Breakers Fuses

    # Bedrooms: # Bathrooms:
     
    # Fireplaces: # Chimneys:
     
    Special features
    (i.e., deck, air conditioning, alarm systems, pool, etc.)
     
    Coverages:
     
    Dwelling Cov. $ Contents $
    Liability Cov. $ Deductible $
    ($250, $500, $1,000, etc.)
     
    Comments/Remarks
    (describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here):
     
    Send my quotation via: E-Mail Fax
    Regular Mail
    Call Me By Phone
    Thank you for filling out this form COMPLETELY!

    We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

    Yes, I Agree. Please Send Me a Quote NOW!

    Click Button Below When Done

    Please Click Only Once . . . May take up to 30 seconds!

    		 
    Website Design © 2010, Insurance Web Sales