Home Quote Form

Answer the questions below one time and receive multiple Texas home insurance quotes back in less than 48 hours.
You don't need to answer every question but the insurance quotes you receive will be more accurate based on the information you provide.

General Contact Information * denotes required information
* First Name : 
* Last Name : 
Email : 
Street Address : 
Apartment/Suite # : 
* City : 
County : 
* State : 
* Zip Code : 
* Home Phone # : 
Work Phone # : 
Fax # : 

How many years in current residence? : 
Do you currently have insurance? :  Yes No
If yes, who is your home insurance provider? : 
Has your home insurance ever been cancelled or non-renewed? : Yes No

Primary Resident Information
Marital Status : 
Date of Birth : 
Social Security # : 
Sex :   Male Female
Occupation : 
Employer : 
Years with Current Employer : 

Structure Information
Is your dwelling a mobile home? :  Yes No
Construction : 
Roof : 
Foundation : 
Year Built : 
Square Feet : 
Central Heating / Air Conditioning :  Yes No
This dwelling has a : 
How many vehicles can the above hold? : 
Home is occupied by : 
Age of Roof (years) : 
# of Rooms (not including garage) : 
# of Full Bathrooms : 
# of Half Bathrooms : 
Trampoline :  Yes No
Hot Tub :  Yes No
Pool :  Yes No
Is dwelling more than 20 years old? :  Yes No
Seasonal Dwelling :  Yes No
In City Limits :  Yes No
Business Activity in Home :  Yes No
Distance to fire hydrant (feet) : 
How far to fire department? : 
Name / City of Fire Department : 
Fireplace :  Yes No
Fire/Burglar Alarm :  Yes No
Is the dwelling occupied during the day? :  Yes No
Animals :  Yes No
Bankruptcy in the last 5 years :  Yes No
Your credit for the last 5 years has been : 

Multi-Policy Discount Information
Are you interested in filling out an auto insurance quote to see if you qualify for additional discounts? : Yes No
Describe any losses you have filed with your insurance provider over the past 5 years (hail, wind, fire, water, burglary) : 

  I wish to receive e-mails informing me of current events at 1st Choice Insurance Agency.
 I understand that the information I have provided above may be passed along to the the insurance companies 1st Choice Insurance works with and that 1st Choice Insurance or those companies may run underwriting reports in order to provide an accurate quote. By submitting the information above, you authorize us or them to run consumer reports including, but not limited to CLUE, MVR, UDD and Credit.

Click Request Quote to send us your information. After receiving your information, we will respond within 48 hours with the best insurance rates we could find.