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Our Quote Lines:
281-494-5187
(Sugar Land, Stafford, Missouri City and Houston Areas)

979-823-2626
(Bryan, College Station, and Surrounding Areas)

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Hotel & Motel Program
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


 
Your Name:
Business Name:
Property Address:
City:
State: (Must be Texas)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail
(again for accuracy):
Phone:
Fax (optional):
 
 
Dwelling Information
 
Year Building Built:
Building Square footage:
 
Occupancy: Motel Hotel
 
Describe Facility Ammenities:
(describe entities such as 26 unit motel with restaurant, pool, and jogging course, etc.)
 
Type foundation: Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
 
Type finished basement, if any: None Full
25% 50% 75%
 
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile Metal Other
 
Type of Siding Brick   Vinyl
Wood   Aluminum
 
Number of stories: One Two
Three 4 or more
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 

 
Coverages:
 
Building Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Other Coverage/Remarks
(describe any extra coverages needed such as business interruption, robbery, computers, etc.):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone

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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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Safenet Insurance Agency
4418 Bluebonnet Drive, Suite 302 | Stafford, TX 77477
Phone: 281-494-5187 | Fax: 877-792-9109 | Texas Ins. Lic#18286
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