Welcome to Farm Bureau Insurance Company
Donald M. Odom, Jr. Agent

Please Note: If you prefer not to complete this form, you may obtain a quote by faxing your current homeowners declaration page to 386 462-3348

 

 

 

 

PERSONAL INFORMATION

Name:
Address:
City:
State:
Zip Code:
E-Mail Address:
Phone Number:
Fax Number:
Current Insurance Company:
Expiration Date:
Policy #:

Home Location

Physical Address of Home:
City:
County:
State: FLORIDA
Zip Code:
Inside City Limits or Outside:

Rating Data

Total Square Footage of Home:
Year Home was Built:
Construction of Home:
Roof Construction:
Number of Levels:
Number of Bathrooms:
Basement:
Fireplace?:
Central Air?:
Garage:

Value

Estimated Value to TOTALLY Replace Home
ie: the amount of Insurance Needed on Home

Claims

Any claims on Home in past 3 years:
If Yes,
Please enter Date of Loss,
Amount of Loss and Cause of Loss

Deductible

Please Choose a Deductible:
Any Comments you feel may be necessary in providing you with this quote:

Thank you for completing our online quote form. We will contact you with a quote within two business days.