Bennett & Bennett Home Page Auto & Home Insurance Commercial Business Insurance Health Insurance Life & Disbility Insurance Estate Planning

Personal Lines: Home/Auto/Umbrella

Bennett & Bennett Insurance can provide you with a wide range of home and auto insurance coverages. To receive a quote from us about insurance to meet your needs, simply fill out the form below and hit the "Submit" button. We will get back to you as quickly as possible.

Home Insurance

Name:
Telephone:
Work Telephone:
Address:
Where is Insurance Now? Any Claims: Yes No
Your Social Security Number:*
Home Value:   Year Built: Construction: Frame  Brick
Foundation: Water Back-Up: Yes No
EQ Coverage: Out-Building Values:
Farm Exposure Yes NoDogs: Yes  No
Trampoline: Yes  No             Swimming Pool: Yes  No
* Social Security Number required to obtain a Credit Score.

Auto Insurance

Any Tickets?     Yes   NoAny Accidents?     Yes   No
DriversD.O.B.G.S./DTVEH #DL #

VehiclesYear/MakeVIN#Commute
Yes  No
Yes  No
Yes  No

Social Security Numbers
Driver 1
Driver 2
Driver 3

OTHER INFORMATION THAT MAY BE REQUIRED:
  • Vans/Eddie Bauers: Ask about special wheels, electronics, custom seating, custom paint job.
  • Tenants: Contents value? Brick or Frame building? How many apartments/suites? How many firewalls?