Home
Client Portal
Auto, Home & Personal Insurance
Commercial | Business Insurance
Our Team
Contact Us

Your address will show here +12 34 56 78 email@example.com

Home
Client Portal
Auto, Home & Personal Insurance
Commercial | Business Insurance
Our Team
Contact Us

Get a Quote

Quick and Easy Quote

Not all of the information in the form is required, but the more information we have, the quicker we can get a quote to you. If you have any questions, or do not want to fill out this form, please call us at (740)-635-0873

Dropdown *

Please let us know what type of Insurance you are requesting a quote for. If you are unsure, please select "Other"

Name *

First

Middle

Last

Date of Birth *

Driver's License Number

This would be for you, or the First name entered above This is needed for auto quotes.

Would you like to add a Second insured or Coapplicant? *

Yes
No

Second Insured | Coapplicant *

First

Last

If there is a Co-applicant on the Insurance Please use this field. This is Normally a spouse on a personal insurance policy.

Date of Birth for Second Insured *

Driver's License Number - Second Insured *

This would be for coapplicant, or the Second name entered above

Phone Number *

Email *

Preferred Contact Method *

Phone Call
Email
Text Message

Address *

Address where the Insurance is taking place. If you are purchasing a new home, the new home address would go here. This is required for all Insurance types.

How long have you lived at this address? *

Less than 5 Years
5 Years or More

How long has the business been at this address? *

Less than 5 Years
5 Years or More

Old Address *

If you have not Lived at your current address for more than 5 years, please indicate your old address here. If you are buying a new home, this would be your old and/or current address. Not your new Purchase.

How Many Cars would you like a quote for? *

1
2
3
4
5
More than 5

Car Make - Model - Year

Please Put in the First Vehicle's Make Model and Year

First Vehicle's VIN *

Please Put in the First Car's VIN Number

Second Vehicle Car Make - Model - Year *

Please Put in the Second Vehicle's Make Model and Year

Second Vehicle's VIN *

Please Put in the Second Vehicle's VIN

Third Vehicle Car Make - Model - Year *

Please Put in the Third Vehicle's Make, Model, and Year

Third Vehicle's VIN *

Please Put in the Third Vehicle's VIN

Fourth Vehicle Car Make - Model - Year *

Please Put in the Fourth Vehicle's Make, Model, and Year

Fourth Vehicle's VIN *

Please Put in the Fourth Vehicle's VIN

Fifth Vehicle Car Make - Model - Year *

Please Put in the Fifth vehicle's Make Model and Year

Fifth Vehicle's VIN *

Please Put in the Fifth Vehicle's VIN

Year House was Built *

Year of Building Construction *

House Construction *

Frame, Masonry, Brick, etc.

Building Construction Material *

Frame, Masonry, Brick, etc.

Square footage of Home *

Square footage of Building *

Is The Roof the Original Roof *

Yes
No
Not Sure

Roof Update Year? *

Was your Roof updated? Just type in the year it was updated!

Does the House Have Knob-and-Tube Wiring? *

Yes
No
Not Sure

Does the Building Have Knob-and-Tube Wiring? *

Yes
No
Not Sure

Electrical Update Year?

Any Updates to the electrical circuit?

Primary Heating Source? *

Forced Air
Boiler
Heat Pump
Hybrid Heating
Ductless Mini-Split(s)
Radiant Heating
Baseboard Heater(s)
Wood Burner/Wood Stove
Other

Secondary Heating Source? [If Applicable]

Forced Air
Boiler
Heat Pump
Hybrid Heating
Ductless Mini-Split(s)
Radiant Heating
Baseboard Heater(s)
Wood Burner/Wood Stove
Other

Any Fire Places?

Yes
No
Not Sure / Non Working Fireplace

How Many Fireplaces do you have?

These are working, non-boarded fireplaces

Wall Type *

Drywall
Plaster
Paneling
Other
Not Sure

Do you have any Pets? *

Yes
No

Please indicate the number of pets, the kind of pet, and what breed they are. *

How Many Employees Do You Currently Have? *

What are your Projected Sales for the Year? *

What Type of Business Do You Operate? *

Lawn Care
Resturant or Bar with more than 70% of Sales from Alcohol
Other

These are NOT "disqualifying" businesses, we just need to ask different questions depending on what you pick.

Other *

Does your House have any of these Security Devices?

Deadbolts
Smoke Alarm
Burglar Alarm
None of the Above
Other

Would you like a Life Insurance Quote Also? *

Yes
No

Would you like a Life Insurance Quote Also? *

Yes
No

This is perfect for owners looking for group life insurance for their employees, Key-Man coverage for important members of your team, or for covering expenses due to the death of an owner or co-owner.

What are you currently paying for Insurance?

Has an Agent from M. C. Thomas Insurance talked with you already? If so, please select their name below *

Matthew Carnes
Gabrielle Carnes (Frasure)
Andrew Dixon
Rob Brown
James Davenport
Scott Carnes
Shelly Carnes
Debbie Stratton
Don Kent
Pam Cope
I'm not sure
No one has talked with me yet

Sign-up to our newsletter?

We promise to not send spam emails, we would like to keep you up to date on any changes in Insurance policies and M. C. Thomas News.

Name

Text Hover

Copyright M.C. Thomas Insurance Agency