Personal
Articles Floater
Insurance Quote
 

We would like to provide you with a free, no-obligation personal articles floater insurance quote. Please complete ALL information so that we may provide you with a quote. This information will be kept confidential and will be used for quote purposes only.

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Privacy Statement: Any information provided by a consumer or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. All submissions will be responded to within two business days.

Disclaimer
I understand that this does not constitute an actual "live" online quote, but is rather a submission of information to Head Insurance Group so that they may put together an insurance proposal (quote) for the above titled risk. There is no obligation on my part to purchase this insurance, and I understand that this online submission does not constitute a statement or contract for insurance.

 I have read and agree with the above disclaimer.
  (Box must be checked before request can be sent)

Personal Information
Applicant's Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:

 
Applicant & Location Information
 
Age:
Marital
Status:
S
 
Occupation:
Spouse's
Occupation:
Territory
Code:
Protect
Class:
Fire District/
Code #:
Location of Property
(if different from above):

Additional Location
Dwelling
Type(s):
Construction
Type(s):
# Families
(in each):
Other:

 
Coverages
Please indicate additional property that is not listed in boxes 10-14
#
Property
Amount of Ins.

#
Property
Amount of Ins.
  1 Jewelry $ 8 Coins $
2 Furs $ 9 Golfer's Equipment $
3 Fine Arts $ 10 $
4 Cameras $ 11 $
5 Musical Instruments $ 12 $
6 Silverware $ 13 $
7 Stamps $ 14 $
Unattended Car Coverage (Stamps/Coins)
Broad Form Pair & Set Coverage
Non-Mobile Organ Coverage
Safe Credit (Identify Property, Safe Class)
ACV Loss Settlement
Replacement Cost Loss Settlement
Breakage Coverage (*On Schedule)
Blanket Coverage
Additional Rating Information

 
General Information
Explain All "Yes" Responses in Remarks
Yes/No

Explain All "Yes" Responses in Remarks
Yes/No
1. Any protective devices/systems in use? Y
N
6. Any other insurance with this company? Y
N
2. Will any property be exhibited? Y
N
7. Did any loss occur during the last 3 years? Y
N
3. Will any special restriction/ endorsements apply? Y
N
8. Any coverage declined, cancelled or non-renewed during the last 3 years? Not applicable in MO Y
N
4. Will any type of deductible apply? Y
N
Prior Insuror & Policy Number
5. Is any property used professionally/ commercially? Y
N
Remarks

 
Schedule of Property
#
Provide a detailed description of each item, from whom purchased, etc. Be sure to forward all required appraisals/bills. Purchase/
Appraisal Date
Amount of Insurance
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Please use the "Additional Comments" section at the bottom of this form for any additional entries.

 
Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you
have additional information where there was not enough fields above, such as
additional coverages, schedule of property, etc..., please enter them here.


Before Submitting Your Information...
I understand that all of the above information MUST BE COMPLETED in order to obtain an Insurance Quote. Head Insurance Group will be unable to provide me an insurance quote if any fields above are left blank or are partially filled in. PLEASE re-check your information before submitting!

 I have read and agree with the above disclaimer.
  (Box must be checked before request can be sent)

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   


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Cedar Park
201 S. Lakeline Blvd. Ste. # 304
Cedar Park, TX 78613
Phone:
Toll Free:
Fax:
Email:
  512-336-2929
  866-377-2929
  512-336-2930
  info@headinsurancegroup.com

Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

 
 
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