Get an
Accu-Quote

Exclusively done by Trojan Insurance

Get an Accu-Quote

We want every quote to be an amount that you can count on and not an amount that will change as soon as you say “Lets do it”. So once you fill out these forms, please allow us some time to personally research the best fit for you at the best price we can find! We will then call you with the right coverage and price information tailored specifically for you!

First, fill out the Basic Information form below.
Then, fill out either the Automotive form, Homeowner’s form, or both for maximum savings!

Your Basic Information

Personal Information
Name* *
Phone
Email* *
Date of Birth* *
Gender
Marital Status
Social Security Number
Driver’s License Number
Street Address *
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Do you Own or Rent your home?
How long have you lived here?* *
If less than 2 years, please list previous address
Occupation?* *
Highest Education
Do we have permission to run a soft hit on your credit report and drivers report?* (This will not affect your credit score at all) *
Automotive Insurance
Personal Information
Name *
Email *
Phone *
Your Driver's License Number *
Texas License? *
Car Information
VIN Number
If No VIN number, please answer the next 4 questions (skip if you have VIN number listed above):
Year of Car
Make, Model and Sub Model info
Number of Doors
2- or 4-Wheel Drive
Safety FeaturesAlarmAutomatic BrakingBlind Spot Detection
How many years have you owned this car? *
Primary Driver of this car *
Primary use of Automobile
Estimate of Number of Miles Driven Each Year *
Is this car used for any of the following services? *
Do you have a loan on this car? *
If so, who is your loan through?
Would you be willing to participate in programs that record your driving habits? *(Most carriers give hefty discounts for participation in these programs)
With whom do you have Insurance now?* *
Years with above Carrier?* *
Years with Continuous Coverage?* *
Date you would like to start coverage *
(Most insurance companies give a discount if you buy 8 days prior to needing)
The next 6 are questions are regarding the Coverage that you prefer. (Feel free to skip them if you do not know your preferences at this time.)
If you are stumped on a question or need to know exactly what each coverage is, please refer to our Insurance 101 page
Liability Insurance
This is the maximum amount your insurance will pay for EACH of the OTHER PERSON'S BODILY INJURIES if the accident is YOUR fault.
Liability Insurance
This is the maximum amount your insurance will pay for the OTHER PERSON'S PROPERTY DAMAGE if the accident is YOUR fault. (Keep in mind the cost of cars these days) YIKES!!!
Medical Payments (Med. Pay) - OR - Personal Injury Protection (PIP)
This is the amount, regardless of who's at fault, that you will receive if you are in an accident for Health Care Expenses and/or funeral expenses. The only difference is that Personal Injury Protection might also pay for lost income, childcare, and other expenses related to the accident. Both may extend to resident passengers or possibly all of your passengers, regardless of living in your home.
Under insured or UNinsured Motorist
This is the amount of money that Your Insurance Company will pay for each of the people in YOUR car and/or your property damage, IF the accident is the Other Person's Fault and they DO NOT have any or enough insurance coverage.
Comprehensive Loss
This is the Deductible that you will pay if Your Car is damaged by or related to theft, animals, vandalism and/or weather.
Collision Coverage
This is the Deductible that you will pay for damage to your car when it hits, or is hit by, another vehicle or other object.
Would you like Roadside Assistance? *
Different carriers may have slightly different services they will offer and/or cover. Following are some of the services that may be offered:
Towing to the nearest repair facility where repairs can be made
Battery jump starts
Tire changes (if you have a functioning spare)
Lockout services (up to $100) if you lock your keys in your vehicle
Fuel delivery to help get you to a gas station or your destination
Would you like a Rental Car option? *
The insurance is usually good up to 30 days and most carriers require you to have Comprehensive and/or Collision Insurance to be eligible.
If available with carrier would you like Extra Glass Coverage?
Please do not fill in this field.
Homeowner’s Insurance

Name *
Email *
Address to insure *
Mortgage Payment or Own? *
If mortgage company is known, please list
Number of People in House *
Estimate of Year Built *
Estimate of Home Value *
Estimate of Purchase Date *
1, 2 or 3 Stories *
Garage (number of cars that are able to park in garage) *
Number of Fireplaces *
Number of Bathrooms *
Have the Bathrooms been updated? *
Has your Kitchen been Updated? *
Type of Heater *
Air Conditioner *
Security?
Cameras monitored by third partyCameras self monitoredAlarm monitored by 3rd partyAlarm self monitoredDead boltsVisible to neighborSecurity gate non manned (or non womaned)Security gate manned (or womaned)
Security?
Do you have a Business that is run out of your house? *
Type of Roof? *
Estimate of year that roof was updated *
How large is your Deck or Patio? *
Have your Plumbing or Electricity been updated? *
Pool or Trampoline? *
Is your yard fenced? *
Types of Dogs (leave blank if you do Not own a dog)
Estimate of Distance to a Fire Hydrant (Feet) *
Estimate of miles to Fire Station (Miles) *
Current Insurance Carrier *
Number of years you have been with that Insurance Carrier? *
The next 5 are questions are regarding the Coverage that you prefer. (Feel free to skip them if you do not know your preferences at this time.)
If you are stumped on a question or need to know exactly what each coverage is, please refer to our Insurance 101 page
Liability Insurance
(This will be the Max amount that you will be covered if someone gets hurt and it's your or your family's fault) Think Lawsuits and not losing any of your possessions because your Coverage was not enough!!!
Medical Payments or Med Pay
(This is the Max amount that your insurance will pay for your visitors to receive Medical Expenses if they are injured on your property.) ie Physician bills, Hospital stays, Physical Therapy, Dental Services, Ambulance Services...
Your Best Estimate of how much it would cost to totally replace your house ($$$)
All Perils Deductible
(This is how much YOU will pay BEFORE your insurance kicks in)
Would you want to have EXTRA coverage with any of these ENDORSEMENTS?
Additional BuildingsHigher Replacement Costs ie 125%, 150% or 200%Ordinance of Law (This would help you if the city or county were 'making' you make an improvement or requirement.)Increased Mold DamageFoundation problems (This may only be offered by some of our carriers)Extra Glass Coverage This may only be offered by some of our carriers)High priced Jewelry, Furs, Watches or CollectionsWater Backup (From Pipes)None of the above
Are you required or do you want FLOOD INSURANCE? *(This covers excessive rain damage, Damage from poor drainage, Rising rivers or Lakes....) This may require that we do an additional policy. Some carriers will offer this coverage, and some will not.

Get an
Accu-Quote

Exclusively done by Trojan Insurance

Get an Accu-Quote

Your Basic Information

Automotive Insurance

Homeowner’s Insurance

Gigi Heyland Franklin

Contact Info