Hodges Insurance Agency

Homeowner's Insurance Quote Form

Please be advised that Hodges Insurance Agency cannot bind, modify or terminate coverage by messages left on our online quote system or by messages sent by email.

General Information

Your Name:
Phone #:

E-mail Address:

Mailing

Address:

City:

State:

Zip:

Property (to be insured)
If different from the mailing address above.

Address:

City:

State:

Zip:

Coverage Amounts

Dwelling Coverage $:
Personal Property Coverage $:
Liability Limits $:
Medical Payments $:	per person
Deductible Amount $	per occurrence

Any Scheduled Property
(Jewelry, Collectables, Coins, Furs, etc.):

Construction and Other Information

Year of Construction:

Dwelling Construction:

Frame Brick/Masonry

Is there a Swimming Pool
on the Premises:

Yes No

Distance to a Fire Department:
Distance to a Fire Hydrant:
Fire District (if known):
Smoke Detectors:	Yes No
Security System:	None Local Central Station
In City Limits:	Yes No

Miscellaneous

Any Pets:

Yes No

If yes...

Describe pets:

Previous Claims History

Any Losses in last 5 years:

Yes No

If yes...	Describe Loss
	Date of loss:
	Amount of loss:

Have you ever had any coverage
canceled or declined?

Yes No

If yes...

Explain:

Current Homeowner's
Insurance Company

Thank you for completing the Homeowner's quote form.
Please click on the Submit the Form button above
to submit the information to Hodges Insurance Agency.

Hodges Insurance Agency will review your information and contact you with a quote.

View our Privacy Policy and Procedures

Hodges Insurance Agency, Inc.
info@hodgesinsurance.com
120 North Main Street
PO Box 330
Louisburg, NC 27549
Office: 919-496-5155
Fax: 919-496-2723

Mon-Fri 9:00AM-5:00PM
And by Appointment

NOTICE OF LICENSURE
Hodges Insurance Agency, Inc. is licensed to conduct business in the state of North Carolina. The information on this site is a solicitation to conduct business only in the aforementioned state of authority.