The Frank Agency - Insurance You Can Trust

Date of Birth
(xx/xx/xx)

Social Sec.
Number

Occupation

Husband:

Contacting Us		Get A Quote		Home

Return to Personal Insurance | Return to "Get a Quote"

This form is for quoting Homeowner's Insurance. Fill this form out as completely as possible. The more information we have the more accurate the quote will be. Completion of this form does not bind coverage. Items with an must be filled in.


Name:

Email Address:

Telephone:

Street Address:

City/State/Zipcode:

Zipcode:

County:

Other County:

Contact Via:

Best Time to Contact:

Occupant Information:

Home Information:

Construction:

Year Built:

Protective Devices:

Current Market Value of Home:

Approximate Content Value:

Deductible:

Additional Property Information:

Fill in dollar values for these special scheduled items listed below:

Jewlery:

Cameras:

Fine Arts:

Musical Instruments:

Area Information:

Responding Fire Dept.:

Inside City Limits:

Feet From Fire Hydrant:

Misc Information:

Number of losses in past 5 years:

Have you filed bankruptcy
in the past 5 years:

Additional Comments or Explanations:

How did you find us:



		Personal Insurance

		Got A Question?

		Get A Quote



		Mail Payments to:

		The Frank Agency, Inc. P.O. Box 877 Middlefield, OH 44062-0877

		Had An Accident:

		For an auto accident, please call the number on the back of your insurance card, then contact us with the details. For all other claims, please call us at 800-782-8328 so we can report the incident to your company.

		Need to Talk:

		800-782-8328 Toll Free 440/632-5656