Kentucky insurance
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Insurance Resources for Kentucky Business Owners & Residents
"Find Out Why We Have Been Central Kentucky's
Insurance Sales & Service Leader for over 100 years!"
Kentucky insurance

Kentucky insurance
Kentucky insurance
Visit Our Agency's
Valuable Kentucky
Insurance Resources:

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Questions?
Please Contact
Us Today!

 
You May
E-mail
Us At:

ewco@ewco-ins.com

Phone: 1-502-348-5921
Fax: 1-502-331-0023
Toll Free: 1-800-999-5921

602 Bloomfield Road
Bardstown, KY 40004

KY Insurance License #'s:
354252 and 354251


"All Our Policies Come With an Agent!"

Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
State: (Must be Kentucky)
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
 
Dwelling Information
 
Were You Interested in a 3 Year Price guarantee policy? YES NO
 
Year Home Built:
Home Square footage:
 
Is this Builder's Risk?
(new home constr.)
NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
 
Type foundation: Slab Crawlspace over slab
Basement Other (list in remarks)
 
Type Roof: Shingle Wood Shake
Tar/Gravel Metal
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
PVC
 
Circuit Breakers or fuses? Breakers Fuses
Currently Insured? Yes No
 
How is Your Credit History?
(Some carriers use credit history to qualify)
 
Prior Claims? Yes No
Describe claims in detail:

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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