JFI New Quote Request

You are more than just a policy to us - our goal is to build a lasting relationship with you. That means we are here to help you every step of the way! If you have any questions, need any assistance with filling out the information below, or would prefer to fill this out over the phone with one of our licensed agents, please do not hesitate to contact us. This form is designed to make it easy for you to get the information necessary for an accurate quote to us on your own time, but we are just as happy to assist you over the phone!

Have a question or comment? Call us at 214-446-2571 or email insurancequotes@judgefite.com.

Client Information (2 of 3)
Is there another person, such as a spouse or partner, that needs to be listed on the insurance policy with you?

YesNo
Spouse/Partner Full Name

First NameLast Name
Spouse/Partner Date Of Birth

MonthDayYear
Date
Spouse/Partner Occupation and Job Title

Information on Checking Credit and Insurance
Many of our insurance carriers run a "soft" credit check, which will not impact your credit score in any way. If you do not feel comfortable giving us your social security number through this form, we can get it later or you can call us with it. We do not have to have it to generate a preliminary quote, but your premium may change once the "soft" credit check is run.

What products are you looking for?
When it comes to shopping for insurance, remember that the more policies we can bundle together, the more discounts are applied. In fact, the largest discount we offer is the bundling discount, so make sure to select both "Home" and "Auto" in the list below if you are shopping for either one!
What type(s) of insurance would you like quoted?

HomeownersAutoRenters (for tenants)Rental (for landlords)MotorcycleWatercraftOther

Ownership Status
Property Address to be Quoted

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the ownership status of this property today?

Will be purchasing this home in the near futureAlready live in this home

High-Value Personal Property
Do you have any high-value personal possessions that you would like listed on your policy with specific values?

YesNo

Please complete the following information for all drivers in your household to be insured on this policy (including yourself):

Auto Insurance - Prior Coverage
Who is your current/prior auto insurance carrier?
How long have they been your auto carrier?
Have you had any tickets or accidents in the last 3 years? Please tell us about them:

Auto Insurance - Coverage
Would you prefer to pay your auto insurance in full or monthly?

In Full (6 or 12 month at a time) *Discount may applyMonthly
The deductible is how much money you have to pay in the event of a claim before the insurance starts paying. What deductible would you prefer to have on your policy?

$250$500$1,000Other
Liability coverage covers other drivers medical payments and property damage when you are at-fault in an accident. Liability limits are offered in three ways - the first number is the medical payment limit per person, the second number is the medical payment limit per accident, and the third number is the property damage limit. What Liability Limits would you prefer to have on your policy?

$50K/$100K/$50K$100K/$300K/$100K (minimum recommended)$250K/$500K/$100K (required if you purchase a personal umbrella policy)

Auto Insurance - Coverage
Do you want to add Uninsured/Underinsured Motorist Coverage to your policy?

Yes (recommended)No
Do you want to add towing/roadside assistance to your policy?

Yes (recommended)No
Do you want to add rental reimbursement coverage to your policy? This would cover a rental vehicle should a covered vehicle be in a covered accident.

YesNo

Renters Insurance
Property Address to be Quoted

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Square Footage of the property
Approximate if unknown
Current Insurance Carrier
Leave blank if not applicable.
If you had to replace everything that you own that is in the house you rent, how much money would you need to do that? (Minimum $15K)
Do you have any high-value personal possessions that you would like listed on your policy with specific values?

YesNo

Rental Property Coverage
Thank you for allowing us to quote your rental property. If you have multiple rentals, please call us so we can assist at 214-446-2571. If you would prefer, enter the first property's information and you can go back to the beginning once this form has been submitted to enter the next property.
Rental Property Address to be Quoted

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the occupancy status of this property today?

The home is currently occupiedThe home is currently vacant, but will have a tenant in the next 30 daysThe home is currently vacant, and will remain so for at least 30 days

Rental Property - Property Info
Does the property have a garage?

YesNo
Total number of parking space in the garage?
Is the garage attached to the house or a separate structure?

AttachedSeperate
How much do you charge in rent per month on this property?
Who manages this rental property?

I use a professional property management companyI manage the property myselfOther
What is the name of the property management company?

Please complete the following information for all drivers in your household to be insured on this policy (including yourself):

	Driver 1	Driver 2	Driver 3	Driver 4
Full Name
Date of Birth
Driver's License State
Driver's License Number
Occupation
Motorcycle Endorsement on Drivers License?

Other Insurance Needs
You indicated that you were interested in coverage for another item. Please tell us what you are looking to insure, and we will gladly follow up with you to provide you with a quote, or you can call us at 214-446-2571.

Ready to Submit!
Thank you for allowing Judge Fite Insurance to provide you with a quote on your insurance needs! Feel free to go back and correct anything before you submit. If you have any feedback or questions or want to let us know anything else about your needs or how we can help, please include that below, and then click Submit to complete this form and send it our way!
Please offer any feedback of additional information or needs here:
Should be Empty: