All Premier Insurance Group

On the net since 02/95.First in Texas.
FREE QUOTE FORM. Fast and secure.

Texas or any one relocating to Texas.We offer Life.Health.Dental.Auto.Property.Bonds.Commercial.

Your quote is prepared by a licensed professional agent, not by software or non licensed part time help as others do. Please fill out all of the form below and click on the "Send Request" button.Please give your e-mail address to return your quote.Your quote will be rated and back to you the same day.If this quote form does not work due to your browser or server problems. Please e-mail us your insurance request.No need to encrypt your quote since we do not need your driver's license # or social security # to rate the quote.We NEVER sell or trade your e-mail address.Thank you! 

            Name: 
   Date or Birth: 
   Male or Female: 
   Spouse: 
      Spouse Date of Birth: 
    Ages/sex of Children: 
   Area/Phone No.: 
  Area/Fax No.: 
   Email Address: 


Your Mailing Address:
   Street/PO Box: 
            City: 
            State: 
            Zip: 



Health and term life quote info:
Are you self employed? Yes No
Tobacco use?      Yes No   
List all who use any form of tobacco?: 
Type of Life Insurance needed:5,10,15,20 or 30 yr Level term.
 
Multiply annual income X 6
Amount of Life Insurance needed:      
Do you have health insurance coverage now? Yes No
Do you want a quote for health insurance?  Yes No
What co-pay for health? $30.00,$600,$1000,$1500,$2000 ded plan.
Specify co-pay,zip code,pre existing cond and tobacco use. 
*MANDATORY FOR A HEALTH QUOTE.*



Auto and homeowners quote info:
Continuous auto insurance in the last 8 months? Yes No
Who is your insurance company now?: 
What Liability limits do you have? 20/40/15, 25/50/25, 50/100/50, 100/300/100
What limits of P.I.P., Medical, U.U./U.I.M., Towing, Rental?
Specify your current liability,P.I.P. and uu/uim limits:
*MANDATORY FOR A VEHICLE QUOTE.*

What are your comp/coll deductibles? 100/100, 250/250, 500/500, 1000/1000
Specify deductibles:
*MANDATORY FOR A VEHICLE QUOTE.*

Do the autos have an alarm or air bags?
If "Yes", please specify:

Are you a home owner?  Yes No   
What type of dwelling do you have? House,Condo,Townhome,Mobile,Apartment
Please specify your dwelling info below:Year built?Value?Sq foot?Type and age of roof?
Construction of dwelling?Alarms and smoke alarms?Zip code?

Have you taken defensive driving in the last 3 years?  Yes No

Have you had accidents or tickets in the last 5 years? Yes No
If "Yes", please specify: 

Type of vehicles? Year,make,auto,motorcycle,truck,van,value
Please specify:



TYPE OF QUOTE:
Check as many as applies
 Term Life.            Classic/Collector Car.         
 Dental.               Personal Auto.     
 Individual Health.    House.                
 $600. deductible            
 $30.00 Dr. Visits     Commercial Auto.                                                         
 $1000.deductible     Yes send apps,ready to buy insurance.

Comments/Special conditions:
NOTE:NOT A FIRM QUOTE.FINAL PREMIUM SUBJECT TO VERIFICATION OF INFO.

THIS IS FOR A QUOTE ONLY.NO COVERAGE PROVIDED UNTIL AN APPLICATION IS SIGNED AND APPROVED. Since we do NOT know you yet.HAVE you given us ALL the info RELATED to the quote you want? PLEASE provide the needed info for your quote we can not guess your needs.Thanks.After you click the send button it will send you back to our home page.Thanks for the request.We insure great people.
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Copyright © 1995,96,97,98,99,2000,01,02,03,04,05,06,07 -All Premier Insurance Group. All rights reserved.
Last update:8.9.2007 Call us at 713.812.7666
All Premier Insurance Group Cheap insurance.