Boone High Country Insurance Agency

blazing the trail to a more secure tomorrow

Boone High Country Insurance can help you with your health insurance needs:

•	Individual Health Insurance
•	Self-employed Individuals
•	Business Group Insurance

Let us help you:

...	make sense of all your health insurance options;
...	explain those insurance terms;
...	locate AFFORDABLE rates for individuals, self-employed, and businesses.
...	find help for you if you are uninsurable because of a medical condition;
...	determine if you are paying too much for health insurance.

Let us answer your insurance questions and help you get the value for your health insurance dollars, all while being insured with a reputable, financially-stable insurance company.

Free Quote

For more information on health care insurance or to get a free quote on any type of insurance, please complete the following information and submit the form when finished:

First Name:	Last Name:
Address:
City:	State: Zip:
Daytime Telephone Number:

Which type of coverage are you interested in:

Health Life Auto Home Business

All information provided is held in strict confidence and is never provided to third parties except insurance coverage providers as necessary. We provide insurance customized for your needs based on the information you provide, so for the best rate possible, please take a moment to complete the following.

Information For Life Insurance or Health Insurance

Date of Birth:

(ex: 01/01/1980)

Amount of Life Insurance Needed:

Any Tobacco Use In Past 12 Months? Yes No

Any Health Problems? Yes No

Taking Any Medications? Yes No

Information For Auto Insurance

Sex:	Male Female
Marital Status:	Married Single
Driver Name:
SSN#:
DOB:	(ex: 01/01/1980)
Driver's Lic. #: State:

Any Violations or At Fault Accidents within the last 3 years? Yes No

Driver:

Vehicle Information

Year: Make: Model:

VIN#:

Miles to Work or School:

Motorcycle

Year: Make: Model:

CCs: Value: $

Information For Homeowners

Year Home Built:
Fire District:
Sq. Footage:
Frame Masonry

Any comments:

Boone High Country Insurance Agency
Downtown City Hall Building
301 Cranberry Street • Newland, NC 28657
Phone: 828-733-6200 • Fax: 828-733-6266
E-Mail: booneins@boone.net

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