Thomason - Tyler - Lynch = Affordable Insurance, Tulsa, Broken Arrow, Oklahoma

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Name
Address
City
ZIP Code
E-mail Address
Phone #
Best Time to Call
Send Quote Via	E-mail Phone
Residents Type
Current Home Insurance	Yes No
If Yes, Current Carrier
Date of Expiration
Social Security Number of all owners
How did you hear about us

Type of Quote Needed
Homeowners	Renters	Mobile Home

Home Information
How Long At Present Address	Year Home Was Built

Sq. Footage (excluding garage & basement)	# of Claims In Last 3 Years:
sq. ft.
Please List any claims within the past three years
None

Structure Information
Type	Construction		Foundation

Roof Type	Roof Age
	yrs
Garage Size		Garage Type

Basic Information
Deck/Porch/Patio		Fireplaces
Deck Sq. Ft.		# of Chimneys
Porch Sq. Ft.		# of Hearths
Screened Patio Sq. Ft		Wood Burning Stove
Bed Rooms	Bathrooms	Basements
	# of Full # of Half	Sq. Ft.

Additional Features
Heating System	Central Air	Central Vacuum
	Yes	Yes
Security Alarm	Fire Alarm	Smoke Detector
		Yes

Underwriting Questions
Swimming pool	Is pool enclosed		Trampoline

Inside city limits	How many acres		Miles to fire dept.

Any Animals		If yes what kind & (breed of dogs)

Please list any updates on Wiring (circuit breakers), Plumbing, and list type of heating system if NOT Central Heat/Air

Amount of coverage on Dwelling		Deductible

Mobile Home Information
Tied Down	Location


	Is Home Skirted
	Yes No

Personal Property Information
How much personal Property coverage	Burglary Coverage Included
	Yes No

Please indicate if you have any additional information which may help us provide you an accurate quote.
Also list any additional items you would like scheduled with $value.

Information submitted will be held confidential and will be used for quote purposes only.
No Coverage will be bound by this form.
By pressing Submit you are authorizing us to verify any information
given to provide you with the best rates and most accurate quote.