Texas Community Insurance Group by Hoffman Financial Services, Inc.

Texas Community Insurance Group by Hoffman Financial Services, Inc. | Tel (972)758-9300 Fax (972)758-9355 | 1400 Preston Rd, Suite 345 Plano, Texas 75093

THE POWER OF PROTECTION972-758-9300

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Renter's Quote

Contact Information
Name:	Phone:
Mailing Address:	City:	State:	Zip:
Location Address:	City:	State:	Zip:
E-Mail:
If you have lived at the above address for less than 3 years, please provide your prior address below:.
Previous Address:	City:	State:	Zip:

Following forms are optional, Please fill in if you would like to provide more information.
Current Insurance Information
Current Insurance Company (not agency)
Date Current Policy Expires	mm/dd/yyyy

Protection Devices Installed		Smoke Detectors	Dead Bolts
		Fire Extinguisher	Central Burglar / Fire Alarm
Property Within City Limits	Yes No
If NO -	Located within the fire district.
Distance in road miles to nearest fire department
Distance to nearest fire hydrant				ft.

Coverage Information ...
Value of Your Personal Property
Value of Unit (if greater than $1,000)
Loss Assessment Coverage ($1,000 improvement coverage included with basic policy)
Liability Coverage Limit	$
Deductible	$

High Value Items
(Item, Value)

These are high value items that need to be specifically identified, including jewelry, silverware, collectibles, furs, etc. Please list each item and its value.

This is a Request For Quotation Only.
No coverage is in effect until bound by an insurance carrier.

Thank You!

Contact Information