How would you prefer to be contacted
regarding your quote?
If you would prefer to be contacted by phone,
please let us know the best time to call.
Do you currently own your home, or rent?
Driver's license number:
Social Security number:
(does not include land value)
Number of Stories
Type of Construction
Central Station Burglar Alarm
Dead Bolt Locks
Is the house in a subdivision?
Age of the owner(s)
Value of jewelry to be covered?
Value of any special art, furs, silver, etc.
Is there a business in the house?
900 N. Herritage St. / P.O. Box 98 Kinston, NC. 28502
Phone: (252) 523-2177 Toll Free: (800) 849-1832 Fax: (252) 523-7217
Kinston Insurance Service Agency, Inc.
copyright © 2002-2003