Robinson Insurance - Focusing our resources to focus on our clients' business.   Please use this form to apply for a quote. We will respond to your request by the next business day. Thank you!   *Indicates a required field. *First Name:   Middle Initial:   *Last Name:   *Street Address:   *City:      State: TX *Zipcode:   *Email Address:   Home Phone:   (ex.999.222.2222) Business Phone:   (ex.999.222.2222) Fax Number:   (ex.999.222.2222) What is the best time to call?   Choose Morning Afternoon Evening Sex:     Male   Female     *Type of home:   Choose Single Family Duplex Condo Other *Total square feet:   *Year Constructed:   *Ground floor square feet:   *Distance from the fire hydrant:   Choose -500 ft 500 ft 1000 ft 2000+ ft *Distance from the fire station:   Choose less than 1 mile 1-2 miles 2-4 miles over 4 miles Smoke detectors:   Choose 1 2 3 4+ N/A Number of fire extinguishers:   Choose 1 2 3 4+ N/A Number of fireplaces:   Choose 1 2 3 4+ N/A *Monitored alarms?     Yes      No *Is your lot larger than 10 acres?     Yes      No *Within city limits?     Yes      No Foundation:   Choose Slab Pier/Beam Post Tension Basement *Construction Type:   Choose Brick Brick Veneer Wood Stucco Other Number of stories:   Choose 1 1.5 2 3+ Full Bathrooms:   Choose 1 2 3 4+ N/A Half Bathrooms:   Choose 1 2 3 4+ N/A Number of Bedrooms:   Choose 1 2 3 4 5 Garage Size:   Choose 1 car 2 car 3 car Carport Is the garage/carport attached?     Yes      No *Age of roof:   *Roof material:   Choose Composition Wood Tile Other Swimming Pool?     Yes      No Fenced?     Yes      No Air Humidifier:     Ceiling Fan(s):   Central Vacuum System:     Electronic Air Filter:     Garage Door Opener(s):   Heat Exchanger:     Hot Tub (inside or outside):     Intercom System:     Interior Sprinkler System:     Jetted Tub:     Microwave (built-in only):     Prefab Fireplace Insert:     Roof Exhaust Fan:     Sauna:     Skylight:     Wet Bar:     Wood Burning Stove:     Do you have an in-home business?     Yes     No If you do have an in-home business, please describe it here:       Current Insurance Carrier and Policy Number:   How long have you had this policy?   ------------------------- > 3 Years 2 Years 1 Year 6 Months 3 Months < 3 Months Any claims in the past 3 years?     Yes     No Please list all claims you have had in the past three years:       *Dwelling Coverage Requested:   Personal Property Coverage Requested:   Requested Deductible:   Choose $1000 1/2 OF 1% 2% 3% 4% 5% Personal Liability Requested:   Choose $300,000 $500,000 $1,000,000 Do you have jewelry you wish to schedule?     Yes     No If you do, what is the replacement value?       Please provide any additional information you desire or special requirements:         Site Contents Copyright 2002, Robinson Insurance. Site design & maintenace by TWG Interactive.