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<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#999933" TEXT="#080000" bgproperties="fixed" background="038006e0ddwnfv.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>A Full-service Internet Insurance Agency selling life, auto and home insurance.    </B></FONT><B>   </B></div> <div> <B>     </B><A HREF="index.htm" TARGET="_top" TITLE="A Fullservice Internet Insurance Agency "><U><B>home</B></U></A><B>  /  </B><B> </B><A HREF="id3.htm" TARGET="_top" TITLE="Products"><U><B>Products</B></U></A><B>  /  </B><A HREF="id2.htm" TARGET="_top" TITLE="About Us"><U><B>About Us</B></U></A><B>  / </B><A HREF="id4.htm" TARGET="_top" TITLE="Whats New"><U><B> What's New</B></U></A><B>  /   </B><A HREF="id5.htm" TARGET="_top" TITLE="Charities"><U><B>Charities</B></U></A><B>  /  </B><A HREF="id16.htm" TARGET="_top" TITLE="Directors"><U><B>Directors</B></U></A><B>  /  </B><A HREF="id6.htm" TARGET="_top" TITLE="Contact Us"><U><B>Contact Us</B></U></A><B>  </B></div> <div> </div> </td> </tr><tr> <td valign="top" width=160 BGCOLOR="#CCCC99" TEXT="#080000" background="040a0c00esnpes.png"> <div> <A HREF="id10.htm" TARGET="_top" TITLE="Auto"><U>Auto</U></A></div> <div> <B>Home</B></div> <div> <A HREF="id9.htm" TARGET="_top" TITLE="Life"><U>Life</U></A></div> <div> <B>Homeowners Insurance protects you from loss in the event your home or possessions</B><B> </B><B>are destroyed, damaged or stolen.  It also provides protection from personal injury suffered by others on your property.</B></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Home Owners or Renters Insurance</B></div> <div> <B>Please fill in the form below to receive a quote</B></div> <bR> <div> <B> <form action="http://formmail.trellix.com/servlets/TlxMailer" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Company,Address1,Address2,City,State,Zip,Phone,Fax,Comments,[Custom]"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for information. A quote will be e-mailed within 24 hrs. Mon through friday.Please note because of the nature of Home Owners insurance you maybe asked for additional coverage."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="charitableinsurance@comcast.net"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Full Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Building Construction (Frame,Masonry,Brick, Aluminum etc.):<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Structure type ( Dwelling, Apart.,Condo,etc.):<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Full address including zip:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Amount of dwelling coverage needed:<br> <input type="text" name="Address2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Deductible:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Primary or secondary residence?:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Year Built:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Have you had any losses during the last 3 years?:<br> <input type="text" name="Fax" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Please list Prior carrier, Policy #, and Expiration date.:<br> <textarea name="Comments" rows="7" cols="30"></textarea></td> </tr> <tr> <td align="left">Do you want the following? Personal injury Coverage, replacement Cost coverage, and please list any special Insurance coverages you may need.:<br> <input type="text" name="[Custom]" size="30" maxlength="100"></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </B></div> </td> </tr></table></body>