Home Insurance Quote Request

To get a quote, you can fill out our online form below, or print out our quote request form and fax it to us at 972-394-7817.

If you fill out our form online, please fax a copy of your current insurance policy to us at 972-394-7817, or scan and email us a copy at quotes@jvminsurance.com.

Fields marked with an asterisk * are required.

Your Name*

Phone *

Your Email *

Date of Birth

Spouse Name


Spouse Email

Spouse Date of Birth


Years at this address:

Own or Rent?

If less than 3 years, prior address

Do you live in this house or lease to others?

Prior insurance company

Length of time with prior company

Year built

Square feet

Roof type

Roof age

Foundation type


Single family or duplex

How many stories?

Garage # of cars

Attached or detached?

Value of jewelry:


Fine arts:




Diving board



Alarm system



Any claims in the past 5 years?

If new purchase, sales price

Loan amount

Do you own rental properties?

If so, list the addresses:

Additional notes

Please answer the following simple math question (this is to prevent automated spam submissions)

Protect Yourself, Your Business, and Your Assets

Whether you or your business needs new insurance coverage, more insurance coverage, or different insurance coverage, contact Jeff Van Matre Insurance Agency today for a personalized quote. We’ll evaluate your unique situation and devise a comprehensive plan that makes sense for you. Don’t delay, call us today at 972-492-8500 or e-mail jeff@jvminsurance.com .

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