Contact Jim Mathews Agency in Billings, MT

 
 
Office: 318-687-7252
Fax:
Email: steveodom2000@yahoo.com
Address: 5914 Fairfield Ave, Shreveport, LA 71106
 
Farmers Union Insurance Office -  insurance agent in Billings, MT
 

 
 
First Name *
 
 
 
Middle Name *
 
 
 
Last Name *
 
 
 
Property Physical Address (Address, City, County) *
 
 
 
Primary Phone Number *

 
 
 
Email Address *

 
 
 
Marital Status *

 
 
 
Occupation

 
 
 
Gender


 
 
 
First Name (Spouse / Partner)

 
 
 
Middle Name (Spouse / Partner)

 
 
 
Last Name (Spouse / Partner)

 
 
 
Birth Year(spouse / Partner)

 
 
 
Gender (Spouse / Partner)

 
 
 
Occupation (Spouse / Partner)

 
 
 
For Auto Quote:
 
Current Insurance Provider (Required for accurate quote) (With in Last 30 Days)
 
 
 
Current Insurance Expiration Date (Required for accurate quote) (Within Last 30 Days)
 
 
 
Current Bodily Injury / Property Damage Coverage
(example: 100,000/300,000)
 
 
 
Current Medical Coverage
(example: 5,000)
 
 
 
Current Uninsured Motorist (example: 100,000/300,000)
 
 
 
Current Underinsured Motorist (example: 100,000/300,000)
 
 
 
Vehicle Year

 
 
 
Vehicle Make

 
 
 
Vehicle Model

 
 
 
Vehicle Identification Number

 
 
 
Additional Vehicles
(please include year, make, model and vin for each additional vehicle)
 
 
For Home Quote:
 
Current Insurance Provider

 
 
 
Current Insurance Expiration Date
 
 
 
Current Deductable
 
 
 
Current Policy Premium
 
 
 
Current Home Value *
 
 
 
Other Structures Value *
 
 
 
Current Liability Coverage *
 
 
 
Property Acreage *
 
 
 
Year Built *
 
 
 
Construction Type
(Stick, Log, Manufactured or other) *
 
 
 
Roof Type (Composition, Steel, Steel, Wood Shingles etc.) *
 
 
 
Fireplace Type (exaplame: Fireplace, Free Standing Wood Stove, Pellet Stove, Gas Fireplace) *