Homeowners Insurance Quote 
In order to provide you with a quote and to determine your eligibility for our programs that we offer through various carriers, our agency and/or companies we represent may use information contained in credit, MVR reports, insurance loss history, and other various consumer reports.  In order to provide you with a quote, our carriers may also develop a credit-based insurance score using these reports and sometimes this is accomplished by using a third party.  For additional information on collection and disclosure of personal information, and your right to see and have the opportunity to correct any personal information in your files, please contact our office.   The reports provide us and/or our carriers with information that assists with determining your eligibility for insurance and the final price you are charged.  By completing these forms, you agree to this process in making a request for a quote.
Homeowner Information
Full Name
 *
Street Address
 *
City
 *
State
 *
Zip Code
 *
Email Address
Daytime Telephone
Evening Telephone
Date of Birth
 *
Your Occupation
 *
Best Time to Reach You
Current Insurance Information
Insurance Company Name (not Insurance Agency/Broker)
Policy Expiration Date
Amount Insured For
 *
Premium Amount
Any Claims in Last 3 Years?
General Information About Your Home
Year Home Built
 *
Total Square Feet
 *
Years at Present Address
 *
Market Value
Liability Coverage
Distance to Nearest Fire Hydrant
Distance to Nearest Fire Department
Who is the Responding Fire Department
 *
Home Type
Home Construction
Roof Type
 *
Age of Roof
 *
Garage Type
Garage
Number of Bedrooms
Number of Baths
Number of Fireplaces
Foundation Type
Comments
Exterior
Deck
Porch
Patio
Screened patio
Finished Basement
If finished what percentage?
 
Additional Information
Swimming Pool
If yes is the pool fenced?
Diving Board
Trampoline
Smoke Detector
Security System
Fire Alarm
Replacement Cost of Personal Items
Any Business Conducted in the Home
Comments
List values of any jewelry furs or speciality items
List pets and breeds
Do you want to include Flood Insurance?
By completing this form you are acknowledging your understanding of and agreement with the following terms:
1. No coverage of any kind is bound or implied by submitting information via this online form.
2. Information from you and other sources such as your driving claims and insurance histories may be used to calculate an accurate price for your insurance.
3. We will not distribute information to other parties other than for insurance underwriting purposes.
4. We value your privacy. Every precaution has been taken to insure your privacy and security.
5. By submitting this form you agree to release us from any liability should this information be accidentally viewed by others.
Security code:
 *
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Have questions or concerns about your insurance?
We can help.
Call 1-800-352-3416

For a quick quote, call us today!
We currently provide insurance services in: 
  • North Carolina
  • South Carolina
  • Virginia

    Please note: Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

    First Casualty Insurance Group, Inc.
    190-A Turner Street
    Southern Pines, NC 28387
    1-800-352-3416
    fciginfo@fcignc.com
     
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