Business Insurance Quote – DAVID VARGAS

Please complete the form below for a quote.

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Please answer all the questions on this form. We look forward to providing as much value as possible and protecting the things that are important to you. Once received, I'll get started right away working on your quotes. By filling out this form, you give us permission to communicate with your via text, email, and phone call. Please see our privacy policy here: https://www.insuranceeptx.com/privacy/

Primary Policyholder Name*

First Middle Last

Your Cell Phone Number*

Your Email*

Date of Birth*

MM slash DD slash YYYY

FOR DISCOUNT PURPOSES ONLY - What is your level of education?***If left unanswered, Highschool or lesser education will be assumed.****

Some highschool or none of the below

High School GED

Bachelors Degree

Masters Degree

Doctorate Degree

Home Address or Best Mailing Address for Rental Property Quote*

Street Address Address Line 2 City State ZIP Code

Name of Spouse (if applicable)

First Last

Spouse Date of Birth (if applicable)

MM slash DD slash YYYY

If you are filling this out yourself (not agent assisted), How did you hear about us or who referred you to us?*

What is most important to you about your insurance?

Price

Agent

Adequate Coverage

How pleased are you with your current insurance advisor/provider?

They are awesome!

Average, I suppose

I am not satisfied with them

Insurance Advisor? Whats that?

What would you like a quote for today?

Auto Insurance

Home Insurance

Renters Insurance (TENANT)

Life Insurance

Rental Property (LANDLORD)

Something Else

How much is your auto insurance monthly?

Who is your current carrier? How long have you been with them?

In order to get a more accurate rate, what are your current auto liability limits? (in thousands)

30/60/25

50/100/50

100/300/100

250/500/100

I don't know

Are there any licensed youthful drivers in your household? (under age 25)

Yes

***DO NOT SKIP!!!*** PLEASE LIST ALL HOUSEHOLD DRIVERS! WE WILL NEED THE FOLLOWING: 1) Name, 2) Date of birth, and 3) license number and state for each driver

Please list all year, make, and models to be quoted here (VINs will help get a much more accurate quote if possible):

Who is your employer and what is your job title? (because discounts are awesome!) **

If we were to do business and help you with your AUTO Insurance, when would you like your policy to start? (We will always quote with max discounts possible and knowing this will help us deliver a more accurate proposal upfront)

IMMEDIATELY or within the next 13 days or less

14 days or more from today's date

Do you own or rent?

Own

Rent

Third Choice

Who insures your home currently? (if applicable) - How much is the yearly premium?

How old is the roof on the home? (years)

Please enter a number from 0 to 100.

What type of roof? (shingle, metal, tile, flat)

REQUIRED - Do you have dogs? And if so how many and what kind?*

Is this quote for a home closing?

Yes

What is your expected closing date? (or desired effective date)

MM slash DD slash YYYY

What contents limit would you like on your policy? (amount to cover your personal belongings)

Address of Rental Property

Street Address Address Line 2 City State ZIP Code

Age of Rental Property Roof?

Please enter a number from 0 to 100.

Something else? Please let us know what you are looking for a quote on:

LAST QUESTION! Let us know how urgent your quote needs are. When would you need your new policy(ies) to start? (Please note we will work your quote as quickly as possible, but this helps us quote more accurately)

TODAY

Within a reasonable amount of time

If you have any other questions, comments or requests, please leave them here, thank you!

Communication Consent (REQUIRED)*

I authorize TWFG - DIS to communicate with me using the information provided on this form for the purpose of assisting with my insurance program.

TWFG - DIS is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text and email as needed.

You may opt-out of all future communication at any time by making your preferences known to us.

TWFG - DIS operates by the simple rule of "treat other people the way you want to be treated."

TWFG - DIS Privacy Policy: https://www.insuranceeptx.com/privacy/

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at TWFG - DelaFuente Insurance Services is here and ready to make the process as painless as possible. We look forward to meeting you!

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