Lenz Insurance - Free Home Owners Insurance Quote

628 N. Main St. | Suite 108
Carroll, IA 51401
712-792-1700
(800)581-2596 | Fax (712)792-0336
Service Beyond Your Expectation!

Let us quote your Iowa home insurance! Please fill in this form and submit it to us. We will contact you by the end of the next business day with a quote.

For the best quote available, please allow us to quote your automobile insurance also.

General Information

*Required Field

*Name

*Home Phone

_{(i.e.1234567890)}

*Address

Work Phone

Address

Fax

*City

*Email Address

*State

Birth date:

*Zip

Prefer contact by:

Social Security Number

Best time to call::

Property Information (if different from above)

Address

City

State

Zip Code

Is property a condo?

*Residence Usage

*Type of Construction

*Year Home Built

Protection Devices Installed

Smoke Detectors

Dead Bolts

Fire Extinguisher

Central Burglar / Fire Alarm

Property Within City Limits

If no..	Located within which fire district?
	Distance in road miles to the nearest fire department
	Distance to nearest fire hydrant (in feet)

*Replacement Cost of Dwelling
*Replacement Cost of Contents
*Any claims on current homeowner insurance?
If so, when, and list the amount of each claim.

Coverage Information
*Dwelling Coverage Amount
*Liability Coverage Amount
*Deductible
*High Value Items (Item, Value) These are high valued items that need to be specifically identified including jewelry, silverware, collectables, furs, etc. Please list each item and its value.
How did you find out about Lenz Insurance?
Questions or Comments?

This is a request for a quotation only.
No coverage is in effect until bound by an insurance carrier.
In order to accurately quote your insurance, a credit check is required.