Bennett & Bennett Insurance Inc - Phone: 812 - 738-2233

Bennett & Bennett Insurance can provide you with a wide range of home and auto insurance coverages. To receive a quote from us about insurance to meet your needs, simply fill out the form below and hit the "Submit" button. We will get back to you as quickly as possible.

Personal Lines: Home/Auto/Umbrella

Home Insurance

First name
Last Name
City
State
Zip Code
Phone
Work Phone
Where is Insurance Now?
Any Claims?
	Yes
	No
Your Social Security Number
Home Value
Year Built
Construction
	Frame
	Brick
Foundation
EQ Coverage
Water Back-Up
	Yes
	No
Out-Building Values
Farm Exposure
	Yes
	No
Dogs
	Yes
	No
Trampoline
	Yes
	No
Swimming Pool
	Yes
	No
Auto Insurance
Any Tickets?
	Yes
	No
Any Accidents?
	Yes
	No
Driver 1 Name
Driver 1 D.O.B.
Driver 1 G.S./DT
Driver 1 VEH #
Driver 1 DL #
Driver 1 Social Security Number
Driver 1 Vehicle Year/Make
Click text Driver 1 VIN #to edit
Driver 1 Commute
	Yes
	No
Driver 2 Name
Driver 2 D.O.B.
Driver 2 G.S./DT
Driver VEH #
Driver 2 DL #
Driver 2 Social Security Number
Driver 2 Vehicle Year/Make
Driver 2 VIN #
Driver 2 Commute
	Yes
	No
Driver 3 Name
Driver 3 D.O.B.
Driver 3 G.S./DT
Driver 3 VEH #
Driver 3 DL #
Driver 3 Social Security Number
Driver 3 Vehicle Year/Make
Driver 3 VIN #
Driver 3 Commute
	Yes
	No
OTHER INFORMATION THAT MAY BE REQUIRED:
•Vans/Eddie Bauers: Ask about special wheels, electronics, custom seating, custom paint job.
• Tenants: Contents value? Brick or Frame building? How many apartments/suites? How many firewalls?