The Williamson Agency

We Sell Insurance In Illinois & Indiana!

Looking for low cost insurance? Have you ever asked what "you" get when you buy an insurance policy? Insurance offers vital protection for the day when you may suffer a loss and need to file a claim. But in addition to that, our policyholders benefit from insurance expertise, free loss control services, convenient payment plans, speedy application and claims processing and much, much more! We provide you with the best insurance products and services available at the most reasonable cost. Call us today or fill out the form below for a quote.

Free - Insurance Quote Request - No Obligation (No coverage is bound by this quote.)
Privacy Notification: A credit report or other investigative report about you may be requested in connection with this quotation for insurance.
*Name :
*Address :
*City :
*State :
*Zip Code :
*County :
Home Phone :
Work Phone :
E-Mail Address :
Contact method:
Are you currently insured?:	Yes No
Expiration date of policies :
Auto	Homeowners

Auto Insurance Information
*List all Drivers/Licensed Operators in the Household including yourself*
Name of Driver 1 :
SS # :
Birth Date M/D/Y:
Sex :	Male Female
Marital Status :	Single Married Separated Divorced Widowed

Name of Driver 2 :
SS # :
Birth Date M/D/Y:
Sex :	Male Female
Marital Status :	Single Married Separated Divorced Widowed

Name of Driver 3 :
SS # :
Birth Date M/D/Y:
Sex :	Male Female
Marital Status :	Single Married Separated Divorced Widowed

Name of Driver 4 :
SS # :
Birth Date M/D/Y:
Sex :	Male Female
Marital Status :	Single Married Separated Divorced Widowed

% Usage each driver - must total up to 100%
	Veh 1	Veh 2	Veh 3	Veh 4
Driver 1	%	%	%	%
Driver 2	%	%	%	%
Driver 3	%	%	%	%
Driver 4	%	%	%	%

Vehicle 1 Information
Model/Year	/
Make/Model	/
VIN Number (From Auto Registration)
If Used for Work, School or Commuter Point Days Per Week/ Miles One Way
/

Vehicle 2 Information
Model/Year	/
Make/Model	/
VIN (From Auto Registration)
If Used for Work, School or Commuter Point Days Per Week/ Miles One Way
/

Vehicle 3 Information
Model/Year	/
Make/Model	/
VIN (From Auto Registration)
If Used for Work, School or Commuter Point Days Per Week/ Miles One Way
/

Vehicle 4 Information
Model/Year	/
Make/Model	/
VIN (From Auto Registration)
If Used for Work, School or Commuter Point Days Per Week/ Miles One Way
/

List all Traffic Convictions/Accidents/Claims in the past 3 years (Give M/D/Y)
Driver 1 Driver 2 Driver 3 Driver 4

Homeowners Insurance Information
General Information (Please note: Coverage is not available for mobile homes.)
Is this your primary residence? Yes No
If no, list address of primary residence :
Address :
City :
State :
Zip Code :
Do you own or rent? Own Rent
If you own, do you occupy or rent to others? Occupy Rent to others Other
Is business (including Farming) conducted on premises? Yes No

*Fire Security Protection*
Is property located inside city or town limits? Yes No
Distance to: Fire hydrant: feet Fire station: miles
Does your home have smoke detectors? Yes No
Professional alarm systems? Yes No

*Complete only for Apartment or Condominium*
Number of units in building?
Construction: Wood Frame Brick/Masonry Aluminum/Vinyl Asbestos Siding Brick Facing Other
Household contents (Includes Personal Belongings) coverage amount requested : $

*Complete only if you are a Homeowner*
Type of dwelling: Single Family Two Family Modular Home Other:
Construction: Wood Frame Brick/Masonry Aluminum/Vinyl Asbestos Siding Brick Facing Other
Year of Construction :
Wood Burning Stove? Yes No
Your estimate of the amount of coverage you will need on your dwelling: $ (Contents coverage amount will be computed based on dwelling coverage amount. If you need special contents coverage, please call.)
Please make sure all information you provide is COMPLETE AND ACCURATE*
*The premiums quoted will be based on the information you provided. Should additional information come to our attention which effects certain rating factors, the premiums originally quoted may be adjusted accordingly. Incomplete information will result in delays in receiving your quotation.

* Required Information