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Church Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Church Information
Church Name
Required
Pastor's Name
Required
Phone Number
Required
Pastor's E-Mail Address
Optional
Church Mailing Address
Required
City
Required
State
Required
ZIP / Postal Code
Required
Contact Information
First Name
Required
Last Name
Required
Primary Phone Number
Required
E-Mail Address
Required
Current Information
Church Property Address
Required
City
Required
State
Required
ZIP / Postal Code
Required
# of Full-Time Employees
Required
# of Part-Time Employees
Required
Annual Payroll (Excluding Pastor)
Required
Pastor's Payroll
Optional
Date Pastor Took Over
Required
/ /
# of Active Members
Required
Desired Amount Of Coverage
Buidling
Required
Contents
Required
Sign
Required
Steeples
Required
Building Information
Construction Type
Required
If "Other", please explain
Optional
Year Built
Required
Square Footage
Required
Roof Type
Required
# of Stories
Required
Seating Capacity
Required
Building Updates
Air Conditioner/Heating
Required
If "Yes", when
Optional
/ /
Exterior Paint
Required
If "Yes", when
Optional
Plumbing
Required
If "Yes", when
Optional
Roof
Required
If "Yes", when
Optional
Wiring
Required
Type of Wiring
Required
Electrical System
Required
Montiored Alarm System
Required
Sprinkler System
Required
Coverage Information
Current Coverage
Required
If "Yes", Carrier name
Optional
Coverage Amount
Optional
Expiration Date
Optional
/ /
Expiring Policy Premium
Optional
Any prior losses
Required
If "Yes", when, amount and type of loss
Optional
Additional Information
Any Church Owned Vehicles
Required
How did you hear about us?
Required
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Toll Free: 1-844-595-3313|Local: 713-655-0335|Fax: 832.834.4261 2201 Caroline|Houston, TX 77002
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