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200 Fox Road, Knoxville, TN 37922
Phone: 865.690.5000 | Toll Free: 1.800.498.1579
Fax: 865.694.9385

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24/7 Claim Filing

Your Contact Information

*Your Full Name:

 
*Your E-mail Address:  

Street Address:

City:

State:     Zip:
Day Phone:
Evening Phone:
Best Way To Contact You:

Applicant

Spouse

Occupation:

Occupation:

Date Of Birth:

mm/dd/yy

Date Of Birth:

mm/dd/yy

Due to some insurance company requirements, we request that you provide your Social Security Number. It has become increasingly common for insurance companies to use general credit scores in order to qualify policyholders for certain discounts and rate structures. Therefore, supplying this number increases our ability to prepare the most accurate quote possible. If you decide not to provide this information, the accuracy of your quote may be reduced.

Social Security #:

Current Homeowners Insurance Information

Insurance Company Name:
Policy Expiration:

Inform Us About Your Home

What Type Of Home Is This Quote For:
Zip Code Where Home Is Located:
County Where Home Is Located:
Distance To Nearest Responding
Fire Station:
Distance To Nearest Fire Hydrant:
How Long At Present Address:
Year Home Was Built:
Lot Size / Acreage:
Sq. Footage:
(excluding garage & basement)
sq. ft.
# of Claims In Last 3 Years:

Structure Information

Structure Type:
Construction Type:
Foundation Type:
Roof Type:
Roof Age: yrs.
Garage Size:
Garage Type:

Structure Features

Deck/Porch/Patio: Deck Sq. Ft.:
Porch Sq. Ft.:
Screened Patio Sq. Ft.:
Fireplaces: # of Chimneys:
# of Hearths:
Bathrooms: # of Full Baths:
# of Half Baths:
Basement:   Sq. Ft.:

Additional Features

Heating System:
Central Air:
Smoke Detectors:
Security Alarm:
Fire Alarm:

Additional Comments
Please leave any comments or additional entries here.

Click "Submit Request" to send your completed quote request.

 

One of our representatives will respond to you as soon as possible.
Thank you for giving us the opportunity to serve you.

Copyright © 2005 The Bolton Insu

Bolton Insurance Agency  200 Fox Road  Knoxville, TN 37922 Phone: 865.690.5000  Toll Free: 1.800.498.1579  Fax: 865.694.9358

Copyright © 2008 The Bolton Insurance Agency

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