Duckworth Insurance Service

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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

Current Renters Insurance Carrier :
Renters Insurance Expiration Date :
Current Automobile Carrier :

Desired Personal Liability Limit :

$100,000 $300,000 $500,000

Current Personal Property Value :
Type of Dwelling You Occupy :
Approximate Age of Dwelling:

Construction Type :

Brick/Stone/Masonary
Aluminum/Vinyl/Asbestos Siding
Frame

Policy Deductible:

$100 $250
$500 $1,000

Check all that Apply :

Smoke Detectors
Fire Alarm Connected to Central Station
Burglar Alarm Connected to Central Station

Distance to Fire Hydrant:
Distance to Fire Department:

Do you operate a business from home?

No Yes

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

Most renters 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 descibe the
type of claim (Include date of loss and amount paid) :