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Dykstra Insurance Agency
2927 NW 122nd St.
Oklahoma City, OK 73120
Phone: 405-751-4865
Toll Free: 877-751-4865
Fax: 405-751-5091
Email: service@dykstrainsurance.com

 




 
Home Owners Insurance

Please fill out and submit the form below and we will get back to you with a quote.  Thank you.

1.  Please provide the following contact information:
First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Contact Phone
E-mail


2.  Please provide the following information about your home:
Year Built:
Approx. Value of Home:
Exterior Construction of Home:
If "Other" please explain:
Garage Size: 
Number of Full Baths: 
Number of 1/2 Baths: 
Type of Roof: 
What is/was the approximate purchase date of your home?
What deductible would you like to consider: 
   
3.  Please fill in the approximate percentage of flooring in your home:
Carpet:  %
Hardwood:  %
Laminate:  %
Ceramic Tile:  %
Other:  %
If "Other" please explain:

 

4.  Please describe your credit history:
 

5.  Have you had any claims in the past 3 years?
 
If "Yes" please explain: 

6.  Discount Eligibility:
 
Multi-Policy:
Age 55 & Retired:
Burglar Alarm:
Monitored Burglar Alarm:
   
Any other comments or questions:
   


You qualify for a multi-policy discount if we also insure your vehicles. After submitting your form go to our Auto Insurance Quote Form to inquire about that service.
   
   

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