Estate Quote - Phillips Stafford Insurance Group

Personal Information

Please provide your personal information.

Your Name(Required)

First Last

Preferred phone number

Your Current Address(Required)

Street Address City State Zip Code

Your Date of Birth

Your Driver's License Number

Your Social Security Number

Marital Status

Your Spouse's Name(Required)

First Last

Spouse's phone number

Spouse's Email

Spouse's Date of Birth

Spouse's Driver's License Number

Spouse's Social Security Number

Home Information

Please provide information for the home you want insured.

Do you own your home?(Required)

Yes

The home I want insured is a new purchase

What is the close date for the home purchase?

What is the new home's address?

Street Address City State ZIP Code

What would it cost to replace all your personal property in your home?

What year was the home's HVAC last replaced

What year was the home's roof last replaced

Is your basement finished?

Yes

Approximately how much of your basement is finished?(Required)

Did you chose to include water & sewer backup coverage on your current policy?

Yes

I don't Know

What is your current deductible for wind or hail claims?

Something Else

I don't know

Do you own a dog?

Yes

Is your dog(s) any of these breeds?(Required)

None Of These

Akita

Alaskan Malamute

American Bulldogs

American Staffordshire

Beaucerons

Belgian Malinois

Bull Terrier

Bull Mastiff

Caucasian Sheperds

Cane Corso (Italian Mastiff)

Chow

Dingo

Doberman Pinscher

Fila Brasileiro

German Shepherd

Great Dane

Husky

Keeshonds

Malamute

Mastiff

Ovcharka

Pit Bull

Presa Canario

Rhodesian Ridgebacks

Rottweiler

Siberian Husky

Staffordshire

Wolf Hybrid

Do you have a pool?

Yes

Does your pool have...(Required)

None of These

A Slide

A Diving Board

A 6 Foot Fence Around The Yard/Pool

Do you have a trampoline?

Yes

Is/does your trampoline...(Required)

None Of These

In A Fenced Yard

Tied/Staked To The Ground

Have A Net Around It

Is your home insurance paid through your escrow account?

Yes

Vehicles

Please provide information on the vehicles you own.

How Many Vehicles Do You Have?(Required)

Year

Make

Model

VIN

Year

Make

Model

VIN

Year

Make

Model

VIN

Year

Make

Model

VIN

Year

Make

Model

VIN

Year

Make

Model

VIN

Drivers

Please provide information for all licensed drivers in your home.

How many drivers are in your household?(Required)

Driver #1's name

Date of Birth

Driver #1's license number

Issuing State

SSN (if not provided above)

Driver #2's name

Date of Birth

Driver #2's license number

Issuing State

SSN (if not provided above)

Driver #3's name

Date of Birth

Driver #3's license number

Issuing State

SSN (if not provided above)

Driver #4's name

Date of Birth

Driver #4's license number

Issuing State

SSN (if not provided above)

Driver #5's name

Date of Birth

Driver #5's license number

Issuing State

SSN (if not provided above)

Driver #6's name

Date of Birth

Driver #6's license number

Issuing State

SSN (if not provided above)

Do you have anything else to add?

File Upload

You can upload current policy documents, jewelry appraisals, or anything else you think would be helpful.

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Estate, Buy-Sell, & Key-Person Quote Request

Personal Information

Home Information

Vehicles

Drivers

Due to the intricacies of an Estate, buy-sell or key-person plan, we prefer to talk with you about your needs before preparing a quote. But you can start the conversation by completing the form below. Our goal is to have a specialist contact you within 1 business day.

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