Welcome
Your life is full of precious things. The people you love. The home you live in. The car you drive. All of them need to be protected.

Duckworth Insurance Service offers products that will provide the best long-term protection for your family and your lifestyle. Products you need to keep the things you value most in life secure and set your mind at ease.
Home/renters insurance
Because it's a lot cheaper than buying everything all over again. Get a quote now.
Auto insurance
Drive Insurance from Progressive serves your auto insurance needs.
Flood insurance
Know that your property will be protected from damages from the next storm.
Business insurance
Whether for-profit or nonprofit, small businesses should have certain kinds of insurance.
Life insurance
High quality, competitively priced life insurance products, including permanent, term, combination and variable policies.

 

Name : 
Address : 
City : 
State : 
Zip : 
  E-mail Address : 
Phone : 
Fax : 


Contact Me Via :
Phone   Fax   E-mail   Postal Mail  


Do You Own or Rent Your Home ? Own  
Rent


  Current Homeowners Insurance Carrier :  
Homeowners Insurance Expiration Date :  
Current Automobile Carrier (optional) :  


Desired Personal Liability Limit on Your Home :   $100,000      
$300,000      
$500,000


Current  
Dwelling Value :  		 $ 
Current Personal  
Property Value :  		 $ 
Year of Construction :  


Construction Type :  
Brick/Stone Veneer    
Brick/Stone/Concrete Block    
Aluminum/Vinyl/Asbestos Siding    
Frame    


Policy Deductible: $100     $250    
$500     $1,000  


Check all that Apply to Your Residence :
Smoke Detectors
Fire Alarm Connected to Central Station
Burglar Alarm Connected to Central Station


Distance to Fire Hydrant:  
  Distance to Fire Department:  


Homeowners Insurance does not cover Floods. Are you Interested in receiving a quote for flood insurance?
 No      Yes


Do you operate a business from home?
 No      Yes
If Yes, what type of business?


Do you have any special hobbies or any items that you would like to specifically insure? If so, please describe items and value:


Most homeowners policies contain special limits of liability on items such as: coins, gold, silver, and other precious metals, silverware, goldware, jewelry, furs, pewter, firearms, watercraft and trailers, business personal property, and fine arts. Enhancements to your policy can be made to provide broader coverage.


Any claims in the past 5 years? If so, please describe the type of claim (include date of loss and amount paid) :


 

 
 
 
Duckworth Insurance Service © 2005