Home Insurance Intake Form

Complete the form below and we will shop our top carriers to find you the best rate on your home. Fields marked * are required.

Applicant Information

First Name *

Last Name *

Property / Home Address *

Mailing Address (if different from property address)

Telephone *

Email Address *

Date of Birth *

Gender

Marital Status

Occupation

Education

Driver License Number

Co-Applicant Name (if applicable)

Current Insurance

Mortgagee (lender/bank holding mortgage)

Name of Current Insurer

When Does Policy Expire?

Non-Renewal Reason (if applicable)

Homeowner's Claim History

Property Details

County *

Year Built *

Sq. Footage *

Bedrooms *

Bathrooms *

Is the Property Occupied? *

Is This a Rental Property? *

Animals / Breed (dogs especially)

Solar Panels?

Date of Last Roof Replacement

Swimming Pool?

Trampoline?

Alarm System?

Plumbing / Electrical Updates

Contact Preferences

Best Time to Be Contacted *

Preferred Contact Method *

Referred By

Additional Notes

Prefer to call?

(469) 461-3381

Mon–Fri 9am–5pm | Sat by appointment

Why Choose AFIG?

We shop multiple carriers for you

Independent — we work for you, not insurers

AM Best-rated carriers only

DeSoto, TX local agency

Fast, no-obligation quotes

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