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Meyer Badenhop Insurance Agency

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We will be glad to provide a competitive quote

To help us supply you with the most accurate quote possible, please answer as many quesitons as you can with the most accurate information available to you. Information submitted will be held confidential and will be used for quote purposed only.

Submission of quote information in no way obligates you to purchase any product or insurance, nor does it represent any agreemnt to provide coverage under any insurance policy.

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Agent Information
Personal Information

[ mm/dd/yyyy ]

A driver's license and social security number is necessary to obtain an accurate quote. A representative from our agency will be contacting you to obtain this information.

We may need to run a credit check. Do we have your permission?

How Many of the following do you have
Do you have the following? Swimming pool?


Burglar alarm?

Sprinkler system?

Kerosene, wood or oil stove?




Exotic pets?
Is your home located Within 1,000 feet from a fire hydrant?

Within 5 miles from the firestation?

On a hillside?

Close to a body of water or susceptible to flooding?
General Questions

Is business conducted on the premises?

Does anyone in your home smoke?

Did you experience any loss or claims in the last 5 years?
Protective Devices Smoke detectors?

Fire extinguishers?

Fire alarm?

Deadbolt locks?
Additional Information Gated community with a securityguard?

Neighborhood watch program?

Senior citizen discount (all occupants age 55 or above)?
Homeowners coverages and deductibles



Additional data Quote requested within

Do you want an umbrella quote?
Optional questions

Do you have any special interests or hobbies that could be considered a home based business?
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