Connect Insurance
50 Forest Mill Trail #100
Mansfield, Texas 76063
(682) 518-6594
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Ownership
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Own a Home
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Own Condominium
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Home Details
Families
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Number of Stories
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Building Type
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Families
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Number of Stories
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Year
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Square Footage
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Construction
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Roof Type
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Roof Shape
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Gable
Hip
Gambrel
Mansard
Complex / Custom
Flat
Shed
Hail Resistant Roof
Do you have a hail resistant roof?
No
Yes
I don't know
Baths
How many full baths (tub, toilet, shower, sink)?
½ Baths
How many half baths (toilet, sink)?
¾ Baths
How many three quarter baths (toilet, shower, sink)?
Heating
How is your house heated?
None
Baseboard Heater
Ceiling Heater
Central Electric
Central Gas
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Wood Burning Stove
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Pool
Do you have a pool?
No
Yes
Pool Type
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Above Ground
In Ground
Trampoline
Do you have a trampoline at this location?
No
Yes
Animals
Do you have any of the following furry friends?
None
Dog - Akita
Dog - Alaskan Malamute
Dog - American Bull Terrier
Dog - American Staffordshire Terrier
Dog - Bull Mastiff
Dog - Chow
Dog - Dingo
Dog - Doberman
Dog - German Shepherd
Dog - Husky
Dog - Pit Bull
Dog - Pit Bull Terrier
Dog - Presa Canario
Dog - Mix
Dog - Rottweiler
Dog - Staffordshire Bull Terrier
Dog - Wolf Hybrid
Dog - Other Breed
Livestock - Cow
Livestock - Horse
Livestock - Other
Pet Insurance
Would you like insurance for your pet?
No
Yes
Earthquake Insurance
Would you like earthquake insurance?
No
Yes
Windstorm Insurance
Would you like windstorm insurance?
No
Yes
Condition
Needs Work
One Star Rating
My place is in need of a few repairs and upgrades.
Good
Two Star Rating
My house has been maintained and is in good condition.
Most properties fall into this category.
Excellent
Three Star Rating
This property is attractive with upgrades and within a desired neighborhood.
Discounts
Car Discount
Currently Insured
No
Yes
Currently Insured
Is this property currently insured?
No
Yes
Prior Carrier
Which carrier are you currently insured with?
Select One
All Other Non Standard Companies
All Other Standard Companies
AAA TEXAS COUNTY MUTUAL INSURANCE CO
ALLSTATE PROP AND CAS INS CO
AMERICAN FAMILY INS CO
BRISTOL WEST INS CO
CHUBB LLOYDS INS CO OF TX
DAIRYLAND COUNTY MUTUAL INS CO
ENCOMPASS PROPERTY AND CAS CO
FARMERS INS CO
FOREMOST COUNTY MUTAL INS CO
GE PROP AND CAS INS CO
GERMANIA FIRE & CASUALTY CO
HARTFORD FIRE INS CO
INFINITY INS CO
LIBERTY COUNTY MUTUAL INS CO
MENDOTA INS CO
MERCURY CASUALTY COMPANY
METROPOLITAN DRT PROP AND CAS INS CO
NATIONAL GENERAL INS
NATIONWIDE PROP & CAS INS CO
OTHER
PROGRESSIVE INSURANCE
SAFECO INS CO OF AMERICA
STATE AUTO P & C INS CO
STATE FARM FIRE AND CASUALTY CO
TRAVELERS INS CO
UNITRIN AUTO AND HOME INS CO
USAA CASUALTY INS CO
Current Monthly Payment
How much do you pay for property insurance each month?
Gated Community
Do you live in a gated community? If so, what type?
Not gated
Single Entry Gated
24-Hour Security Patrol
24-Hour Manned Gates
Pass-Key Gates
Burglar Alarm
Is your property actively monitored with a burglar alarm?
None
Monitored
Unmonitored
Fire Alarm
Is your property actively monitored with a fire alarm?
None
Monitored
Unmonitored
Contents
Computers
Do you have computers, laptops and tablets?
No
Yes
Electronics
Do you have stereos, TVs, game consoles and other electronics?
No
Yes
Jewelry
Do you have a lot of jewelry?
No
Yes
Applicant
Date of Birth
Gender
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Marital
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Education
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Industry
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Homemaker(full-time)
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Sports/Recreation
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Occupation
What is their role?
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Owner Operator
Do you own or operate this business?
No
Yes
Business Insurance
Would you like insurance for your business?
No
Yes
Co-Applicant
Is there a co-applicant?
No
Yes
Co-Applicant
Name
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Lang.LastName
Relation
Relation to
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Insured
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Parent
Date of Birth
Gender
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Complex / Custom
Flat
Shed
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