You may contact us anytime via phone or email, or by filling out this quote sheet. We will make every effort to respond to your questions within 24 hours.
Lee Financial & Insurance Agency, Inc.
An Independent Agent
(405) 843-6427
We are licensed to serve Oklahoma
* This field can not be left
blank
|
|
Full Name *
|
|
|
|
Home Address *
|
|
|
|
How long you have live in this house?*
|
|
|
|
Contact Information
|
|
|
|
Phone #*
|
|
|
|
Best Time To Call
|
|
|
|
|
|
Fax #
|
|
|
|
Email*
|
|
|
|
|
|
House Information
|
|
|
|
Dwelling Amount Coverage
|
|
|
Year Built
|
|
|
|
|
|
|
Living Area Square Feet
|
|
|
Type Of Roof
|
|
|
|
|
|
|
Current Coverage & Policy
|
|
|
|
Current Coverage
|
|
Insurance Company Name
|
|
|
|
How long with this company
|
|
|
|
Expiration Date
|
|
|
|
|
Cost
|
|
|
|
|
|
|
|
|
Comments, Questions, Information Requested:
|
|
|
|
|
|
|
|
|
|
|
|