Please be sure form is filled out completely. Incomplete forms will be delayed.
* Insured
* Requested by
* Need by (date/time)
* Policy Number
Lender
Address (Line 1)
Address (Line 2)
City
State
Zip Code
Attention
Phone Number
Fax Number
Email Address
Title Company
Contact
* Type of Construction Choose one: New Construction Remodel Commercial
If project is a remodel and includes coverage for the existing structure, give breakdown of existing structure value and improvement value.
If project is a commercial job and valued over $200,000, please call our office for a quote.
* Address Location
* State
Homeowner
* Insured amount
Existing Value
*Improvements Value
* City
* Zip Code
* Construction start
(Sales price minus lot)
Additional comments
Special wording may not be approved by your Insurance Carrier. Please allow extra time for such requests, and/or please call your account manager to discuss. Coverage may not be available for all products in all states. Please see Licensing/Legal Page for more information.
Thank you for your interest in LegacyTexas Insurance. We received your inquiry, and one of our team members will contact you very soon. We look forward to serving you!