• 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 (1 of 3)

  • Are you a current Judge Fite Insurance Client
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  •  -
  • Preferred Method of Contact

  • 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?
  • Spouse/Partner Date Of Birth
     - -
    2 digit month, 2 digit day, 4 digit year

  • Client Information (3 of 3)

     

  • Do you have or plan on having any pets?

  • 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?

  • Ownership Status

     

  • What is the ownership status of this property today?

  • Ownership Status - New Purchase

     

  • Estimated Closing Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Will you have a mortgage on your new home?
  • Will you be moving into the home within 60 days of taking ownership?
  • Are you a first time home buyer or not owned a home within the last 3 years?
  • Are you currently working with a Century 21 Judge Fite Company Real Estate Professional?

  • Ownership Status - Occupied

     

  • Do you currently have a mortgage on your home?

  • Property Information

     

  • Has the roof been replaced since the home was built?
  • Has the air conditioning/heating system been replaced since the home was built?
  • Has the plumbing been replaced since the home was built?
  • Has the electric wiring/fusebox been replaced since the home was built?
  • Has the hot water heater been replaced since the home was built?

  • Property Information

     

     

  • Do you have a monitored alarm system or plan on getting one within 30 days of move-in? (Must provide alarm certificate for discount)
  • Do you have or plan on having a trampoline on the premises?
  • Does the property have a swimming pool?
  • Is there a fence around the swimming pool?
  • Does the pool have a diving board?
  • Does the pool have a pool slide?
  • Do you have or plan on having a hot tub/spa?

  • Property Information

     

     

  • Do you plan on operating a business out of the home, where customers will enter your home?
  • Do you plan to ever rent your home to another person on a short term basis, such as through Airbnb, VBRO, or another similar service?
  • Is your home in a federally-mandated flood zone, a low lying area, or near a body of water?
  • Would you like to receive a quote on Earthquake Insurance (this is not included in the standard home insurance policy)
  • Would you like to get a quote for Umbrella Insurance, giving you extra protection above the primary limits of your home or auto policy?
  • How much coverage would you like on your Umbrella Policy?

  • High-Value Personal Property

     

     

  • Do you have any high-value personal possessions that you would like listed on your policy with specific values?
  • Please indicate the approximate value in each category if coverage over $2,500 is needed in any one area.
    Rows

  • Auto Insurance - Driver Info

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

  • Auto Insurance - Vehicle Info

  • Please complete required information on all automobiles that you would like insured on this policy.

  • Vehicle 1 - Do you want Full Coverage or Liability Only?
  • Vehicle 1 - What is the ownership status of this vehicle?

  • Vehicle 1 - Is this vehicle titled in another parties name?
  • Would you like to add another vehicle?
  • Vehicle 2 - Do you want Full Coverage or Liability Only?
  • Vehicle 2 - What is the ownership status of this vehicle?

  • Vehicle 2 - Is this vehicle titled in another parties name?
  • Would you like to add another vehicle?
  • Vehicle 3 - Do you want Full Coverage or Liability Only?
  • Vehicle 3 - What is the ownership status of this vehicle?

  • Vehicle 3 - Is this vehicle titled in another parties name?
  • Would you like to add another vehicle?
  • Vehicle 4 - Do you want Full Coverage or Liability Only?
  • Vehicle 4 - What is the ownership status of this vehicle?

  • Vehicle 4 - Is the vehicle titled in another parties name?
  • Would you like to add another vehicle?
  • Vehicle 5 - Do you want Full Coverage or Liability Only?
  • Vehicle 5 - What is the ownership status of this vehicle?

  • Vehicle 5 - Is the vehicle titled in another parties name?
  • Would you like to add another vehicle?
  • Vehicle 6 - Do you want Full Coverage or Liability Only?
  • Vehicle 6 - What is the ownership status of this vehicle?

  • Vehicle 6 - Is the vehicle titled in another parties name?

  • Auto Insurance - Prior Coverage

  • Auto Insurance - Coverage

  • Would you prefer to pay your auto insurance in full or monthly?
  • 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?

  • 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?

  • Auto Insurance - Coverage

  • Do you want to add Uninsured/Underinsured Motorist Coverage to your policy?
  • Do you want to add towing/roadside assistance to your policy?
  • 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.

  • Renters Insurance

  • Do you have any high-value personal possessions that you would like listed on your policy with specific values?
  • Please indicate the approximate value in each category if coverage over $2,500 is needed in any one area.
    Rows

  • 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.

  • What is the occupancy status of this property today?

  • Rental Property - Ownership Status

  • Is this home a new purchase?
  • What is your estimated closing date?
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does or will this property have a mortgage on it?

  • Rental Property - Owner Info

  • Rental Property - Property Info

  • Has the roof been replaced since the home was built?
  • Has the air conditioning/heating system been replaced since the home was built?
  • Has the plumbing been replaced since the home was built?
  • Has the electric wiring/fusebox been replaced since the home was built?
  • Has the hot water heater been replaced since the home was built?

  • Rental Property - Property Info

  • Do you allow your tenant to own a vicious breed of dog?
  • Is there a trampoline on the premises?
  • Does the property have a swimming pool?
  • Is there a fence around the swimming pool?
  • Does the pool have a diving board?
  • Does the pool have a pool slide?
  • Do you have or plan on having a hot tub/spa?

  • Rental Property - Property Info

  • Does the property have a garage?
  • Is the garage attached to the house or a separate structure?
  • Who manages this rental property?

  • Motorcycle Coverage - Driver Info

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

  • Motorcycle Coverage - Bike Info

  • Please complete required information on the motorcycle that you would like insured on this policy.  If you have more than 1, please call us at 214-446-2571 or submit this form for the first bike and then go back to enter your other bike(s).

  • Did you purchase this motorcycle new or used?

  • Do you want Full Coverage or Liability Only?
  • What is the ownership status of this motorcycle?

  • Is this motorcycle titled in another parties name?

  • Watercraft Coverage

  • Please complete required information on the watercraft that you would like insured on this policy.  If you have more than 1, please call us at 214-446-2571 or submit this form for the first watercraft, and then go back to enter your other watercraft.

  • What type of engine?

  • Did you purchase this watercraft new or used?

  • Do you want Full Coverage or Liability Only?
  • Do you want coverage for your boat trailer?
  • What is the ownership status of this boat?

  • Is this watercraft titled in another parties name?

  • Other Insurance Needs

  • 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!

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