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Insurance Types

W.A.George Insurance Agency has prepared the following general information form for your convenience to help you compile and submit the basic information we’ll need to assist you in obtaining the proper insurance to meet your needs.

Type of Quote Needed (check all that apply):

Personal Coverage Business Coverage Financial Coverage
Homeowner
Renter’s Insurance
Condo Coverage
      Insurance
Auto Insurance
Umbrella Liability
      Insurance
Boat & Yacht       Insurance 		Commercial Property
Commercial General       Liability
Business Automotive       Coverage
Worker’s Compensation       Coverage
Day Care Coverage
Commercial Excess       Liability

Universal Life       Insurance
Health/Medical       Insurance
Disability Coverage

*Name:
 
*Birth Date: (MM/DD/YYYY)  
  Title:  

Property Insurance
Casualty Insurance
Health Insurance
Life Insurance
Auto Insurance
 
  Company Name (if applicable):  
*Phone:  
*e-Mail:  
  Mailing Address:  
*City:  
*State:  
*Zip:  

 

Briefly describe current insurance need:

*Are you currently insured for this need: Yes No

*Is this request time sensitive?
Quote is not time sensitive
Need formal quote within 5 days
URGENT: Need formal quote within 24 hours



   
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