Please use the following form to request a quote for homeowners or flood insurance.

Contact Information
Street address:
City: State: Zip:
E-mail address:
Home phone: Work phone:
Cell phone: Pager:
Preferred method(s) of contact: Home phone Cell phone Fax
Work phone Pager E-mail

Homeowner/Renter/Mobile Home Information
I would like a quote for: Homeowner/Renter/Mobile Home Insurance
Flood Insurance
Street address:
City: State: Zip:
Home is inside outside city limits of:
Construction of home:
Year of construction:
Square footage:
Year Last Re-roofed:
Wiring: Aluminum Copper
Elevation of home: feet above sea level
Number of stories:
Number of bedrooms:
Number of families:
Distance to fire hydrant: feet
Distance to nearest fire station: miles
Number of claims during past 3 years:
Name of current company:
My insurance expires on    
I have: a burglar alarm a smoke alarm
Amount of coverage on home: $
Amount of coverage on personal belongings: $
My premium is paid by me or my mortgage company.

©2010 Buhl Insurance Agency Inc., Privacy Policy
Site Design By:
facebook linkedin