Hughes Insurance Agency "We Work Hard to Save You Money"

Home Insurance
- get a quote

For more information call Todd at 651-645-1096

You can feel secure in filling out this form. Your personal information will NOT be stored online and is available ONLY to Todd Hughes and staff.

Name:

Phone:

Best time to call:

Address:

Previous Address:
(if less than 3 years)

Your Email:

Social Security #:
(optional but useful)

Date of Birth:

Gender:

Marital Status:

House Information:

New Purchase(y/n):

Purchase Date:

Purchase Value:

Construction Year:

House Type:

Main Square feet:

Lower Sqare feet:

Upper Sqare feet:

Lower % Finished:

Walkout(y/n):

Attached Garage(y/n):

Garage Size:

Pets(y/n):

Smokers(y/n):

Pool(y/n):

Wood Stove(y/n):

Alarms:

Burglar alarms(y/n):

Smoke alarms(y/n):

Fire alarms(y/n):

Sprinklers(y/n):

Updates & year
(e.g.electrical- 2006):

Current Insurance:

Current Carrier:

Amount Insured:

Expiration Date: