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Please fill out the following form for
a Homeowners insurance quotation
in the state of Kentucky. After clicking the submit button,
the form will be sent to The Lancaster Agency and an agent will contact you to review a personalized
quotation. Please note that The Lancaster Agency is authorized
only to write insurance in the state Kentucky.
If you have any questions about this form or
about coverage in general, please contact us.
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Personal
Information
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| Name
(first, middle, last) : |
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| Address
Line 1: |
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| Address
Line 2: |
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| City,
State Zip |
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| E-mail: |
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| Home
Phone (000) 000-0000 : |
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| Work
Phone (000) 000-0000 : |
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| Fax
(000) 000-0000 : |
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| Social
Security # (required): |
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| Best
time to call: |
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Residence
Information
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Type of policy (homeowners,
condo, renters):
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| Effective
date of coverage (00/00/0000) : |
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| Location
of residence (if different from above): |
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| City,
State Zip |
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| Is this
a Primary or Secondary residence: |
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| Approximate
year of construction (0000) : |
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| Construction
type: |
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| Any losses
in the last 3 years: |
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| Number
of families at residence: |
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Coverage
Information
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| Value
of home, or amount of current insurance: |
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Personal property
amount
(condo
and renters only):
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| Personal
Liability (each occurrence): |
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| Deductible:
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Endorsements:
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Replacement
cost options
(check all that apply): |
Dwelling:
Contents:
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Protective
devices
(check all that apply): |
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Optional
Coverages:
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| Earthquake
Coverage: |
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Scheduled
Property
(enter an amount for all that apply): |
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| Comments
or additional pertinent information: |
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Submitting an insurance quotation
request to The Lancaster Agency does not constitute a binding confirmation
of new or altered insurance coverage. Verbal or written confirmation must
be obtained from The Lancaster Agency to confirm binding or altering
coverage. |
