top of page

Homeowner’s Quote Request

Disclaimer


By submitting this form, you agree to be contacted by Gilliland Insurance and its subsidiary Rick the Insurance Guy regarding your insurance inquiry. Rick Gilliland, owner and founder of Gilliland Insurance and Rick the Insurance Guy, will be the only person to contact you. Completing this form does not guarantee coverage or bind any insurance policy. All quotes are subject to underwriting approval and may require additional information. We respect your privacy and will never share your information without your consent. For full details, please see our [Privacy Policy] and [Terms & Conditions].

Quote Request Below

Birth Date
Month
Day
Year
Do you currently have homeowner’s insurance
Yes
No
How old is the roof on the home you wish to insure?
Yes
No
How much coverage do you need?
$10,000-$50,000
$50,001-$100,000
More than $100,000
More than $300,000
More than $500,000
Is there a mortgage on the property?
Yes
No

“None” if no mortgage

 

© 2025 by Rick The Insurance Guy

​

bottom of page