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Interactive eRequest Section

We offer a selection of online forms to help facilitate a speedy quote back to you.

 

INTERACTIVE QUOTE REQUEST FORMS:  

(CLICK LINK TO VIEW)

#

Name

Description

Link

1.

AUTO INSURANCE QUOTE

Auto Insurance Quote - Interactive

Auto

2.

HOME INSURANCE QUOTE

Home Insurance Quote - Interactive

Home

3.

BUSINESS INSURANCE QUOTE

Business Insurance Quote - Interactive

Business

 4.

 CERTIFICATE OF INSURANCE

 Certificate & Auto ID Request From

Certificate

 

Brochures

 

 

#

Name

Description

Link

1.

 AGENCY  SALES BROCHURE

Tri-Fold Brochure

Brochure

 

 

Applications & Forms

 

We offer a selection of Standardized ( ACORD) Insurance Applications & Forms to help facilitate  speedy quotes and/or underwriting reviews. These applications do not bind any requested coverage as  written notice of approval & acceptance of coverage may only be issued to by the issuing insurance companies underwriting staff  .  We are authorized  representatives for several leading insurance carriers and/or Managing General Agencies. ACORD applications are generally accepted by  insurance carrier underwriting departments as these forms have been approved by most State Insurance Regulatory Departments. Customized Business Insurance/ Homeowners / Non-Standard Auto Programs that have been  developed for a Specific Risk Groups or Business Classifications by a carrier and/or Managing General Agencies we represent. Applications for other business classification or insurance product lines not listed herein may  be requested by calling us at 1-800-361-8734 or  emailing:  edhemphill@hemphillinsuranceagency.

 

Interactive Fillable PDF Forms 

Adobe PDF Downloadable Forms

   

PERSONAL AUTO RELATED FORMS:

 (CLICK LINK TO DOWNLOAD ~ VIEW ~ PRINT )

#

Name

Description

 

Download Link

Fillable Link

1.

 ACORD 90TX

Texas Personal Auto Application

 

PDF

PDF Fillable

2.

 ACORD 11

Auto Accident Information Form

 

PDF

PDF Fillable

3.

 ACORD2

Automobile Loss Notice

 

PDF

 

4.

 E.I.A. CHANGE

Coverage Change  Request

 

 

5.

 DPS  DL-64

Change Address/Updated License

 

 

6.

 FORM 130U

Motor Vehicle Title Application

 

 

7.

 VTR-14G

Address Change Vehicle Registration

 

 

8.

 VTR-60

Replacement License Plate/Sticker

 

 

9.

 VTR-214

Application For Disabled Person

 

 

10.

 ACORD 12

Exchange Of Information Form

 

PDF

 

11.

 ACORD 13

Witness Card

 

PDF

 

12.

 TEXAS DPS

New Resident Auto Information

 

 

13.

 TXDOT

Tips To Prevent Auto Theft

 

 

 

HOMEOWNERS / DWELLING  RELATED FORMS:

(CLICK LINK TO DOWNLOAD ~ VIEW~ PRINT )

#

Name

Description

Download Link

Fillable Link

1.

ACORD 80

Homeowners Application

PDF

PDF Fillable

2.

ACORD 84

Dwelling Fire Application

PDF

 

3.

ACORD1

Property Loss Notice

PDF

PDF Fillable

4.

ACORD 42

Residential Property Replacement Cost

PDF

PDF Fillable

5.

ACORD 18

Jewelry Appraisal And Claim Evaluation

 

6.

ACORD 67TX

Homeowners Personal Property Supplement

PDF

 

7.

BAD RO23A

Residential Homestead Exemption Application

 

8.

E.I.A. CHANGE

E.I.A. Coverages Change Form

 

9.

TEXAS FAIR PLAN

Description Of Coverages

 

10.

TEXAS FAIR PLAN

Frequently Asked Questions

 

11.

TX  50-135

Application For Disabled Veteran Exemption

 

12.

ACORD 64TX

Application For Windstorm And Hail Insurance

PDF

 

13.

ACORD 69TX

TX Special Mobile Home Windstorm/Hail App

PDF

 

 

COMMERCIAL  /  BUSINESS RELATED FORMS:

(CLICK LINK TO DOWNLOAD ~ VIEW ~ PRINT )

#

Name

Description

Download Link

Fillable Link

 1.

 ACORD 160

 Businessowners Policy - Application

PDF

PDF Fillable

 2.

 ACORD 185

 Restaurant/Tavern Supplement

PDF

 

3.

ACORD 125

Commercial Insurance Application

PDF

PDF Fillable

4.

ACORD 126

Commercial General Liability

PDF

PDF Fillable

5.

ACORD 127

Business Auto Application

PDF

PDF Fillable

6.

ACORD 129

Vehicle Schedule - Business Auto

PDF

PDF Fillable

7.

ACORD 137TX

Texas Commercial Auto Application

PDF

PDF Fillable

8.

ACORD 140

Commercial Property Section

PDF

9.

ACORD 163

Commercial Auto Driver Information

PDF

PDF Fillable

10.

 ACORD 146

 Commercial Equipment Floater

PDF

11.

ACORD 138TX

Texas Garage and Dealers

PDF

 

12.

ACORD 175

Commercial Policy Change Request

PDF

PDF Fillable

13.

ACORD 28

Evidence of Commercial Insurance

PDF

 

14.

ACORD 3

Liability Notice of Claim

PDF

PDF Fillable

 15.

ACORD 130

Workers Compensation Application

PDF

PDF Fillable

 16.

 ACORD 4

 Workers Compensation -                  1st Report of Injury or Illness

PDF

PDF Fillable

 17.

 FSS-4

 Employer Federal Tax Id - Application

PDF

 

18.

 CERTIFICATE OF INSURANCE

 Request Certificate or Auto ID Card

PDF

 

OTHER FORMS:

(CLICK LINK TO DOWNLOAD ~ VIEW ~ PRINT )

#

Name

Description

Download Link

Fillable Link

1.

ACORD 82

Watercraft Application

PDF

 

2.

ACORD 83

Personal Umbrella Application

PDF

 

3.

ACORD 35

Cancellation Request/Policy Release

PDF

PDF Fillable
 4.  ACORD 36  Agent Of Record Change

PDF

PDF Fillable

 

Interactive Fillable MSWORD.DOC Forms 

Interactive Fillable PDF Forms 

Adobe PDF Downloadable Forms

WORKERS COMPENSATION APPLICATIONS &  RELATED FORMS:

(CLICK LINK TO DOWNLOAD ~ VIEW ~ PRINT )

#

Name

Description

Fillable MSWORD DOC

Download  PDF

 Link

Fillable PDF

 

 Link

1.

ACORD 130

Workers Compensation Application

PDF

PDF Fillable
 2.  ACORD 4  Workers Compensation - First Report of Injury or Illness

PDF

PDF Fillable
 3.          
 4.  Dwc81.pdf  TDI - DWC-81, Agreement Between General Contractor and Subcontractor to Provide Workers’ Compensation Insurance     PDF Fillable
 5.  Dwc82.pdf TDI - DWC-82, Agreement Between Motor Carrier and Owner Operator to Provide Workers’ Compensation Insurance Coverage / Agreement to Require Owner Operator to Act as Employer     PDF Fillable
 6.  Dwc83.pdf  TDI - DWC-83, Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers / Agreement to Establish Employer-Employee Relationship for Certain Building and Construction Workers     PDF Fillable
 7.  Dwc84.pdf  TDI - DWC-84, Exception to Application of Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers  

 

  PDF Fillable
 8.  Dwc85.pdf TDI - DWC-85, Agreement Between General Contractor and Subcontractor to Establish Independent Relationship     PDF Fillable
 9.  WC-RFI.doc  TDI - Workers' Compensation- Request for Information

PDF