Renters Insurance Quote Form

Insurance for North Carolina
708 Spartanburg Hwy. NC 28792
(828) 692-8277
Fax:(828) 696-8181 Email
Hours: Mon. - Friday, 8:30 a.m. - 5:00 p.m.

Barnette and Coates Insurance, Inc.
Renters Insurance
Quote Application

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Complete & send the following form to obtain your FREE Renters Insurance quote.

This insurance application will allow you to request a quote for Homeowners Insurance. When the form is submitted, the information will be sent to an agent in our office, who will generate a quote and email that information to you.

Be sure to have this information available in order to complete the application:
1. Address, including zip code, of the insured home.
2. Value of the property to be insured.

First name

Last name

Middle initial

Street address
Address (cont.)
City
County
State
Zip/Postal code
Phone
FAX
E-mail

Zip Code of property

Type of construction:

Residence:

Personal Property coverage: $

Do you want replacement coverage on the Personal Property?

Personal Property value: $

Use this space to enter any special comments you have
regarding the Personal Property to be insured:

How would you like for us to contact you? What would be the best time to contact you?

Zip Code of property
Type of construction:
Residence:
Personal Property coverage:	$
Do you want replacement coverage on the Personal Property?
Personal Property value:	$