Barfield Insurance and Financial Services, Inc.

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Homeowners Quote Request

To obtain a quote please complete the following survey as completely and accurately as possible or call either (407) 293-1009 or (863) 293-5400 for a quote. . Once submitted the information will be e-mailed to our office(s) and we will expedite your request. This information will be kept confidential and will be used for quote purposes only. We look forward to serving you.

Fields marked with a Red asterisk * are required.

Fields marked with a Blue asterisk * , at least 1 of the fields must be filled in.

Contact Information
* Name:
Address:
City:  State:   Zip:
Phone: * Work:
* Home: 
   
 Fax: 
* Email Address:

 

Current Policy Information
Current Insurance Company:
Policy Expiration Date:

Home Value to be Covered:


OR Renter's Contents:

Deductible:
($500, $1000, Other)
Liability Coverage:
($100,000, $300,000, Other)
Current Annual Premium:
# of Claims in Last 3 Years:

 

Property Information
Is Location to be Insured Same as Above: No   Yes
If 'No' Above, Please Complete Location Information:

City:  State:   Zip:
Ownership: Own   Rent
Property Is A: Home   Condominium* Townhouse Apartment
* If Condo - Number of Units in the Building

 

Structure Information
Type
Construction
Roof
Foundation
Garage
Sq. Ft.:
(excluding basement & garage)		  
 		  

 

Features
Bathrooms
Deck/Porch/Patio
Fireplaces
# of Full:
# of Half:
Deck Sq. Ft.:
Porch Sq. Ft.:
Screened Patio Sq. Ft.: 		# of Chimneys:
# of Fireplaces:
Woodburning Stove:
No Yes
Swimming Pool Trampoline Pets

No   Yes

 # of Pets:
Claims?:

 

Security/Systems
Central Air
 Dead Bolts
Security Alarm
Fire Alarm
Smoke Detector
No
Yes		 No
Yes

Extinguishers?
No Yes

 No
Yes

 

Additional Considerations/Requests
Please give any additional comments you feel appropriate for this quotation.


Please click on the "Submit Request" button to send us your quote request.

 

    

© 2010 Financial Visions

Securities and Investment Advisory Services offered through James W. Barfield as a Registered Representative and Investment Adviser Representative of Nationwide Securities, LLC P.O. Box 183137, Columbus OH 43218, (888) 753-7364. Member FINRA, SIPC. A Registered Investment Advisor. DBA Nationwide Advisory Services, Inc. in AR, FL, IL, WV. DBA Nationwide Advisory Services in MA, NY, OK. Representative of Nationwide Life Insurance Company, and affiliated companies and other companies.
Monday, September 6, 2010

Securities and Investment Advisory Services offered through James W. Barfield as a Registered Representative and Investment Adviser Representative of Nationwide Securities, LLC P.O. Box 183137, Columbus OH 43218, (888) 753-7364. Member FINRA, SIPC. A Registered Investment Advisor. DBA Nationwide Advisory Services, Inc. in AR, FL, IL, WV. DBA Nationwide Advisory Services in MA, NY, OK. Representative of Nationwide Life Insurance Company, and affiliated companies and other companies.