ROBERTS & ASSOCIATES

FRED A. ROBERTS, AGENT

ph: 979-378-2221
fax: 979-378-2360
alt: 877-378-2377 Toll free
froberts@txins1.com

Please fill out the information below and click the submit button. We will call you within 24 hrs.

**If inquiring about vehicle insurance, please fill out our form on the "vehicle page"**

*Name: First and Last

*Phone Number:

*Email:

*Effective Date for Policy

*Location Address: *Please include county as well*

Address to House/Property to be insured. (Address, City, State, Zip, County)

Year Home/ Property was Built:

Is it a Primary or Secondary Residence:

Exterior Material of Home:

Roof Type and Age:

Foundation Type:

Living Area Sqft:

Number of Stories:

Garage (Yes/No): If yes, is the garage attached or detached?

Basement (Yes/No): If yes, include Sqft and is it Finished out?

Any Porches (Yes/No): If yes, total sqft and are the porches covered or open?

Any other Structures: If yes, please list: type, size, roof, foundation, and value of structures.

Any Swimming Pool/s (Yes/No): If yes, is there a locked fence around the pool or property?

Any Dogs (Yes/No): If yes, list the number and breed/s.

Livestock/Use of Property:

Water Supply: (Well or Public)

Distance to Fire Station and/or Hydrant:

Monitored by Alarm (Yes/No): If yes, what type of alarm system?

Coverage Value and Replacement Cost: (Please also list Deductible Value)

Personal Property (Estimated amount or %):

Do you want to include Liability Coverage:

Any Loss History/Claims:

Prior Carrier if any:

Payment Type: (Direct or Escrow?)

Comments:

Tell us a little more about your insurance needs.
Please list any other additional information that may be relevant to the property to be insured.

Submit Your Message:

ph: 979-378-2221
fax: 979-378-2360
alt: 877-378-2377 Toll free
froberts@txins1.com