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HEI Agency.Com has many financially strong companies to choose from, allowing us to get you the best price and coverages possible.

Just fill out the form below as much as you can. The fields marked with an asterisk (*) are required to submit the form.  We will call you today if submitted during working hours, no later than the next day if submitted after working hours.

 

If you have any questions or had rather talk to an agent, please call 1-866-808-9171

 

	Tell Us About Yourself
	First Name *
	Last Name *
	Mailing Address *
	City
	State
	Zip Code *
	Day Phone *
	Evening Phone
	Date of Birth *
	Email Address *
	Please Rate Your Credit	Please Select Excellent Above Average Average Below Average
	Tell Us About Your Property
	Property Address *
	Property City
	Property State
	Property Zip Code *
	Mortgage Balance
	Market Value
	Number Of Families
	Dwelling Type ID
	Bedroom Qty
	Bathroom Qty
	Half Bathroom Qty
	Fireplace Qty
	Porch Deck Qty
	Porch Deck Square Feet
	Year Built
	Purchase Date
	Construction Type	Please Select Brick Stone Frame Masonry Superior Log Cabin Frame Stucco Masonry Veneer Asbestos Shingle
	Stories
	Ground Floor Square Feet
	Building Square Feet
	Topography	Please Select Flat Land Gentle Hillside Next To a Cliff Terraced Hill 15% or Less Hill 16-30% Steep Hill Over 30%
	Foundation Type	Please Select Crawl Space Piers/Pilings/Stilts Slab on Grade Unfinished Basement Hill 15% or Less Hill 16-30% Steep Hill Over 30%
	Flood Zone	Please Select Not in Flood Zone Within 100 Ft. 100 to 500 Ft. 500 to 1000 Ft. More Than 1000 Ft.
	Water Body Distance
	Garage Type	Please Select Garage No Carport 1 Carport Attached 2 Carport Attached 1-4 Carport Detached 5 or More Carport Detached 1-4 Car Garage Attached 5 or more Car Garage Attached
	Roof Covering	Please Select Architectural Shingles Asphalt/Fiberglass Shingles Built Up/Tar and Gravel Clay Tile Concrete Tile Corrugated Steel Mineral Fiber Shakes Mission Tile Rock Roof Roll Roofing Rubber Roof Slate Tin Wood Fiber Shingles Wood Shake
	Roof Updated	Yes No
	Roof Update Year
	Pool	Yes No
	Pool Fenced	Yes No
	Pool Fence Lockable	Yes No
	Pool Diving Board	Yes No
	Pool Slide	Yes No
	Fire Protection Distance	Please Select 1000 ft or less to hydrant and 5 mi or less to fire station Over 1000 ft to hydrant and 5 MI or less to fire station Over 5 up to 10 MI to fire station Over 10 MI to fire station
	Building In Brush	Yes No
	Brush One Mile	Yes No
	Brush Clearing 250	Yes No
	Smoke Alarm	Yes No
	Fire Extinguisher	Yes No
	Deadbolts	Yes No
	Electrical Updated	Yes No
	Circuit Breakers	Yes No
	Circuit Box Copper	Yes No
	Central Air	Yes No
	Heating Air Age
	Thermostat Control	Yes No
	Energy Source	Please Select Gas Electrical Oil Propane
	Heating System Type	Please Select None Electrical Gas Oil Heat Pump
	Cooling System Type	Please Select None Central Air Evaporative Cooler
	Plumbing Updated	Yes No
	Plumbing Copper	Yes No
	Fire Sprinklers	Yes No
	Theft Alarm	Yes No
	Fire Alarm	Yes No
	Monitored Alarms	Yes No
	Earthquake Zone Name
	Earthquake Retrofitted	Yes No
	Fire District Name
	Trampoline	Yes No
	Acres
	Dogs	Yes No
	Dogs Quantity and Breed
	Other Pets	Yes No
	Other Pets Quantity and Description
	Tell Us About Your Existing Coverage
	Company
	Expiration Date (mm/dd/yyyy)
	Claim Within 5yr	Yes No
	Claim Within 5yr Description
	Dwelling Coverage
	Other Structure Coverage
	Personal Property Coverage
	Loss Of Use Coverage
	Premise Liability	Please Select $100,000 $300,000 $500,000
	Policy Deductible	Please Select $100 $250 $500 $750 $1000 $2500 $5000
	Earthquake Deductible	Please Select No Earthquake Coverage 10% 15% 20% 25% 30%
	Building Replacement Cost	Yes No
	Contents Replacement Cost	Yes No
	Comments/Remarks

           

NEWS:

Hudgins & Elkin Insurance is an independent insurance agency that can get you a quote and write you protection with many companies to choose from. We are not tied and bound to one company. We find what best works for you.

We offer coverage from only financially strong companies, giving you the best protection available. Coupled with our personalized service, our program is hard to beat.

We respect your privacy. If you prefer to talk to us in person, give us a call - 1-866-808-9171

Our specialty is serving you with the service you deserve.

 

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