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Home Insurance Quote Request Form

<!DOCTYPE html><html lang="en"><head><meta charset="utf-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge" /><title>Home Insurance Quote Request Form</title><meta name="viewport" content="width=device-width, initial-scale=1"><meta name="robots" content="noindex, nofollow"><meta name="description" content="Piedmont Oklahoma independent insurance agency offering auto, car, home, business, boat and recreational vehicle insurance."><base href="https://secureformsolutions.com/assets/paragonokc.com/"><link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.4/css/bootstrap.min.css"><link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.4/css/bootstrap-theme.min.css"><link rel="stylesheet" href="https://ajax.googleapis.com/ajax/libs/jqueryui/1.12.1/themes/smoothness/jquery-ui.css"><link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.6.2/css/font-awesome.min.css"><link href="https://fonts.googleapis.com/css?family=Yanone+Kaffeesatz:300,400" rel="stylesheet"><link rel="stylesheet" href="design/1810/style.php/style.scss"><!--[if lt IE 9]><link rel="stylesheet" href="design/1810/ie.css"><script src="https://oss.maxcdn.com/html5shiv/3.7.2/html5shiv.min.js"></script><script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script><![endif]--><!--[if lt IE 8]><link rel="stylesheet" href="https://alicorsolutions.com/scripts/4.2/css/bootstrap-ie7.css"><![endif]--><link rel="icon" href="files/icon-144.png"><link rel="shortcut icon" href="files/favicon.ico"><link rel="apple-touch-icon" sizes="57x57" href="files/icon-57.png" /><link rel="apple-touch-icon" sizes="72x72" href="files/icon-72.png" /><link rel="apple-touch-icon" sizes="114x114" href="files/icon-114.png" /><link rel="apple-touch-icon" sizes="144x144" href="files/icon-144.png" /><meta name="twitter:card" content="summary" /><meta property="og:url" content="https://paragonokc.com/sfs"><meta property="og:title" content="Home Insurance Quote Request Form"><meta property="og:description" content="Piedmont Oklahoma independent insurance agency offering auto, car, home, business, boat and recreational vehicle insurance."> <meta property="og:image" content="https://paragonokc.com/files/logo.png"> <meta name="thumbnail" content="https://paragonokc.com/files/logo.png" /> </head><body class="body-page body-full-width"><div id="skrollr-body"><div class="top-strip visible-xs"><div class="container">Call Us: <a href="tel:4052839250" class="phone-link">405-283-9250</a>&nbsp; &bull; &nbsp;<a href="online-insurance-quotes">Request a Quote</a></div></div><div class="header-wrapper"><header class="masthead"><div class="container"><div class="row"><div class="col-xs-12 col-md-3 header-logo"><a href="https://paragonokc.com"><img src="files/logo.png" id="logo" alt="Paragon Insurance"></a></div><div class="col-xs-12 col-md-9"><div class="navbar navbar-default" role="navigation"><div class="container"><div class="navbar-header"><button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#navigation" aria-expanded="false" aria-controls="navigation"><span class="sr-only">Toggle navigation</span><span class="icon-bar"></span><span class="icon-bar"></span><span class="icon-bar"></span></button><a class="navbar-brand visible-xs" href="#">Menu</a></div><div class="collapse navbar-collapse" id="navigation"><ul class="nav nav-justified navbar-nav"><li><a href="https://paragonokc.com/" target="_self" aria-label="Home">Home</a></li><li><a href="https://paragonokc.com/about" target="_self" aria-label="About">About</a></li><li class="dropdown drop-cols-2 hidden-sm"><a target="_self" href="https://paragonokc.com/personal-insurance" class="dropdown-toggle disabled" data-toggle="dropdown" role="button" aria-label="Personal">Personal <span class="caret"></span></a><ul class="dropdown-menu"><li><a target="_self" href="https://paragonokc.com/personal-insurance/atv-insurance" aria-label="ATV">ATV</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/car-insurance" aria-label="Auto Insurance">Auto Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/boat-insurance" aria-label="Boat &amp; Watercraft">Boat &amp; Watercraft</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/condo-insurance" aria-label="Condo Insurance">Condo Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/earthquake-insurance" aria-label="Earthquake">Earthquake</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/flood-insurance" aria-label="Flood Insurance">Flood Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/home-insurance" aria-label="Homeowners Insurance">Homeowners Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/individual-life-insurance" aria-label="Individual Life Insurance">Individual Life Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/mobile-home-insurance" aria-label="Manufactured / Mobile Home">Manufactured / Mobile Home</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/rv-motorhome-insurance" aria-label="Motor Home">Motor Home</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/motorcycle-insurance" aria-label="Motorcycle Insurance">Motorcycle Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/umbrella-insurance" aria-label="Personal Umbrella">Personal Umbrella</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/pet-insurance" aria-label="Pet Insurance">Pet Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/recreational-vehicle-insurance" aria-label="Recreational Vehicle">Recreational Vehicle</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/renters-insurance" aria-label="Renters Insurance">Renters Insurance</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/collector-car-insurance" aria-label="Collector Car">Collector Car</a></li><li><a target="_self" href="https://paragonokc.com/personal-insurance/wedding-insurance" aria-label="Wedding Insurance">Wedding Insurance</a></li></ul></li><li class="dropdown drop-cols-3 hidden-sm"><a target="_self" href="https://paragonokc.com/business-insurance" class="dropdown-toggle disabled" data-toggle="dropdown" role="button" aria-label="Business">Business <span class="caret"></span></a><ul class="dropdown-menu"><li><a target="_self" href="https://paragonokc.com/business-insurance/agri-business" aria-label="Agribusiness">Agribusiness</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/apartment-building-insurance" aria-label="Apartment Building Owners">Apartment Building Owners</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/builders-risk-insurance" aria-label="Builders Risk">Builders Risk</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/business-owners-policy" aria-label="Business Owners Policy (BOP)">Business Owners Policy (BOP)</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/church-insurance" aria-label="Church Insurance">Church Insurance</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/commercial-auto-insurance" aria-label="Commercial Auto">Commercial Auto</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/commercial-property-insurance" aria-label="Commercial Property">Commercial Property</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/commercial-umbrella-insurance" aria-label="Commercial Umbrella">Commercial Umbrella</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/condo-assoc-owners-insurance" aria-label="Condo Association">Condo Association</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/contractors-insurance" aria-label="Contractors">Contractors</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/crop-insurance" aria-label="Crop Insurance">Crop Insurance</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/cyber-liability-insurance" aria-label="Cyber Liability">Cyber Liability</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/directors-officers-insurance" aria-label="Directors &amp; Officers">Directors &amp; Officers</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/errors-omissions-insurance" aria-label="Errors and Omissions">Errors and Omissions</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/farm-insurance" aria-label="Farm &amp; Ranch">Farm &amp; Ranch</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/liability-insurance" aria-label="General Liability">General Liability</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/group-life-insurance" aria-label="Group Life Insurance">Group Life Insurance</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/landlord-insurance" aria-label="Landlord Insurance">Landlord Insurance</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/oil-gas" aria-label="Oil / Gas Operators">Oil / Gas Operators</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/professional-liability-insurance" aria-label="Professional Liability">Professional Liability</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/restaurant-insurance" aria-label="Restaurant">Restaurant</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/trucking-insurance" aria-label="Truck &amp; Trucking">Truck &amp; Trucking</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/workers-comp-insurance" aria-label="Workers Compensation">Workers Compensation</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/special-event-insurance" aria-label="Special Event Insurance">Special Event Insurance</a></li><li><a target="_self" href="https://paragonokc.com/business-insurance/hotel-insurance" aria-label="Hotel / Motel">Hotel / Motel</a></li></ul></li><li class="dropdown drop-cols-3"><a target="_self" href="https://paragonokc.com/online-insurance-quotes" class="dropdown-toggle disabled" data-toggle="dropdown" role="button" aria-label="Quote&nbsp;Request">Quote&nbsp;Request <span class="caret"></span></a><ul class="dropdown-menu"><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/apartmentowners" aria-label="Apartment Building Owners">Apartment Building Owners</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/boat" aria-label="Boat &amp; Watercraft">Boat &amp; Watercraft</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/bonds" aria-label="Bonds">Bonds</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/builders_risk" aria-label="Builders Risk">Builders Risk</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/business" aria-label="Business Owners Policy (BOP)">Business Owners Policy (BOP)</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/church" aria-label="Church Insurance">Church Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/commauto" aria-label="Commercial Auto">Commercial Auto</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/comm_building" aria-label="Commercial Property">Commercial Property</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/condo" aria-label="Condo Association">Condo Association</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/condominium" aria-label="Condo Insurance">Condo Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/contractors" aria-label="Contractors">Contractors</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/crop" aria-label="Crop Insurance">Crop Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/cyberliability" aria-label="Cyber Liability">Cyber Liability</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/dando" aria-label="Directors &amp; Officers">Directors &amp; Officers</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/earthquake" aria-label="Earthquake">Earthquake</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/eando" aria-label="Errors and Omissions">Errors and Omissions</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/farm" aria-label="Farm &amp; Ranch">Farm &amp; Ranch</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/flood" aria-label="Flood Insurance">Flood Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/general" aria-label="General Interest">General Interest</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/liability" aria-label="General Liability">General Liability</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/grouplife" aria-label="Group Life Insurance">Group Life Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/homeowners" aria-label="Homeowners Insurance">Homeowners Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/life" aria-label="Individual Life Insurance">Individual Life Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/jewelry" aria-label="Jewelry Floaters">Jewelry Floaters</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/mobilehome" aria-label="Manufactured / Mobile Home">Manufactured / Mobile Home</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/motorcycle" aria-label="Motorcycle Insurance">Motorcycle Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/oil" aria-label="Oil / Gas Operators">Oil / Gas Operators</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/umbrella" aria-label="Personal Umbrella">Personal Umbrella</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/general" aria-label="Pet Insurance">Pet Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/profliability" aria-label="Professional Liability">Professional Liability</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/rv" aria-label="Recreational Vehicle">Recreational Vehicle</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/renters" aria-label="Renters Insurance">Renters Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/restaurantquote" aria-label="Restaurant">Restaurant</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/truck" aria-label="Truck &amp; Trucking">Truck &amp; Trucking</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/workcomp" aria-label="Workers Compensation">Workers Compensation</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/hotel" aria-label="Hotel / Motel">Hotel / Motel</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/quickauto" aria-label="Auto Insurance Quick Form">Auto Insurance Quick Form</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/quickhome" aria-label="Home Insurance Quick Form">Home Insurance Quick Form</a></li></ul></li><li><a href="https://paragonokc.com/partners" target="_self" aria-label="Partners">Partners</a></li><li class="dropdown drop-cols-2"><a target="_self" href="https://paragonokc.com/customer-support" class="dropdown-toggle disabled" data-toggle="dropdown" role="button" aria-label="Support">Support <span class="caret"></span></a><ul class="dropdown-menu"><li><a target="_self" href="https://paragonokc.com/customer-support/payments-and-claims" aria-label="Payments &amp; Claims">Payments &amp; Claims</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/add_driver" aria-label="Add Driver Request Form">Add Driver Request Form</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/addvehicle" aria-label="Add a Vehicle Form">Add a Vehicle Form</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/autoid" aria-label="Auto ID Card Request">Auto ID Card Request</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/certrequest" aria-label="Certificate of Insurance">Certificate of Insurance</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/address" aria-label="Change of Address Form">Change of Address Form</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/commrenewal" aria-label="Commercial Renewal Review">Commercial Renewal Review</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/plrenewal" aria-label="Personal Renewal Review">Personal Renewal Review</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/policychange" aria-label="Policy Change Request">Policy Change Request</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/feedback" aria-label="Questions & Comments">Questions & Comments</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/remove_driver" aria-label="Remove Driver Form">Remove Driver Form</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/removevehicle" aria-label="Remove Vehicle Form">Remove Vehicle Form</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/survey" aria-label="Survey">Survey</a></li></ul></li><li class="dropdown drop-cols-1 hidden-sm"><a target="_self" href="https://paragonokc.com/customer-resources" class="dropdown-toggle disabled" data-toggle="dropdown" role="button" aria-label="Resources">Resources <span class="caret"></span></a><ul class="dropdown-menu"><li><a target="_self" href="https://paragonokc.com/customer-resources/insurance-companies" aria-label="Our Companies">Our Companies</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/client-center" aria-label="Client Center">Client Center</a></li><li><a target="_self" href="https://paragonokc.com/customer-resources/links" aria-label="Helpful Links">Helpful Links</a></li><li><a target="_self" href="https://paragonokc.com/customer-resources/privacy" aria-label="Privacy Policy Statement">Privacy Policy Statement</a></li><li><a target="_self" href="https://paragonokc.com/customer-resources/sitemap" aria-label="Site Map">Site Map</a></li><li><a target="_self" href="https://secureformsolutions.com/form/paragonokc.com/refer" aria-label="Refer a Friend">Refer a Friend</a></li><li><a target="_self" href="https://paragonokc.com/customer-resources/glossary" aria-label="Common Insurance Terms">Common Insurance Terms</a></li></ul></li><li><a href="https://paragonokc.com/blog" target="_self" aria-label="Blog">Blog</a></li><li class="dropdown drop-cols-1"><a target="_self" href="https://paragonokc.com/contact" class="dropdown-toggle disabled" data-toggle="dropdown" role="button" aria-label="Contact">Contact <span class="caret"></span></a><ul class="dropdown-menu"><li><a target="_self" href="https://paragonokc.com/contact/" aria-label="Piedmont Office">Piedmont Office</a></li><li><a target="_self" href="https://paragonokc.com/contact/557" aria-label="Shawnee Office">Shawnee Office</a></li></ul></li></ul></div></div></div></div></div></div></header></div><div class="sticky-social-container hidden-xs"><ul class="sticky-social"><li><a href="https://www.facebook.com/ParagonInsuranceOKC/" class="clearfix" aria-label="Visit Facebook (opens in a new tab)" target="_blank"><img src="https://alicorsolutions.com/cdn/social/material/facebook.png" alt="" aria-hidden="true"> <span class="social-title">Facebook</span></a></li><li><a href="https://twitter.com/paragonokc" class="clearfix" aria-label="Visit Twitter (opens in a new tab)" target="_blank"><img src="https://alicorsolutions.com/cdn/social/material/twitter.png" alt="" aria-hidden="true"> <span class="social-title">Twitter</span></a></li><li><a href="https://www.linkedin.com/company/paragonokc/" class="clearfix" aria-label="Visit LinkedIn (opens in a new tab)" target="_blank"><img src="https://alicorsolutions.com/cdn/social/material/linkedin.png" alt="" aria-hidden="true"> <span class="social-title">LinkedIn</span></a></li><li><a href="https://www.yelp.com/biz/paragon-insurance-piedmont" class="clearfix" aria-label="Visit Yelp (opens in a new tab)" target="_blank"><img src="https://alicorsolutions.com/cdn/social/material/yelp.png" alt="" aria-hidden="true"> <span class="social-title">Yelp</span></a></li><li><a href="https://https://www.instagram.com/paragonokc/" class="clearfix" aria-label="Visit Instagram (opens in a new tab)" target="_blank"><img src="https://alicorsolutions.com/cdn/social/material/instagram.png" alt="" aria-hidden="true"> <span class="social-title">Instagram</span></a></li><li><a href="https://paragonokc.com/blog" class="clearfix" aria-label="Visit Blog (opens in a new tab)"><img src="https://alicorsolutions.com/cdn/social/material/blog.png" alt="" aria-hidden="true"> <span class="social-title">Blog</span></a></li></ul></div><div class="content-wrapper"><div class="container"><div class="row"><div class="col-md-12 hidden-xs"><ul class="breadcrumb"><li><a href="./"><img alt="Home Page" src="https://alicorsolutions.com/cdn/icon/64/000000/home.png"></a> <span class="divider"></span></li><li class="active">Secure Form</li></ul></div></div><div class="row"><main class="col-xs-12"> <div class="page-footer"><div id="sfs"><div> <div id="title_div"> <h1>Secure Home Insurance Quote Request Form</h1> </div> <div id="form_div"> <div id="instructions_div"> To start your Home Insurance Quote Request Form, just fill out the required information below. </div> <script src="https://www.google.com/recaptcha/api.js" async defer></script> <script> function submitStart(token) { var input = $("<input>") .attr("type", "hidden") .attr("name", "start") .val("start"); $('#qqform').append(input).submit(); } function submitQq(token) { var input = $("<input>") .attr("type", "hidden") .attr("name", "qq") .val("qq"); $('#qqform').append(input).submit(); } </script> <div id="basics_div" class="sfs-smaller"> <form id="qqform" name="form1" action="https://secureformsolutions.com/form.php?ref=paragonokc.com&amp;form=homeowners" method="post" onsubmit="return checkVals()"> <input type="hidden" name="form_name" value="homeowners" /> <input type="hidden" name="form_section" value="personal" /> <input type="hidden" name="form_id" value="19" /> <input type="hidden" name="form_domain" value="paragonokc.com" /> <div class="smurf-container"><label for="smurf" style="display:none;">Please leave this feel blank</label><div class="smurf"><input type="text" id="smurf" name="smurf" value="" /></div></div> <fieldset class="sfs-fieldset"> <div class="sfs-input-title"><div id="names"> <table border="0" cellspacing="0" cellpadding="0"> <tr> <td>&nbsp;</td> </tr> <tr> <td>Your Name:</td> </tr> </table> </div> </div> <div class="sfs-input-wrapper"> <table border="0" cellspacing="0" cellpadding="0" style="margin-bottom:5px;"> <tr> <td class="fine_print" style="padding-left:5px"><label for="fname">First <span class="sr-only">Name</span></label></td> <td class="fine_print" style="padding-left:5px"><label for="lname">Last <span class="sr-only">Name</span></label></td> </tr> <tr> <td><input type="text" name="fname" id="fname" style="width: 80px" /></td> <td><input type="text" name="lname" id="lname" style="width: 116px" /></td> </tr> </table> </div> <label> <div class="sfs-input-title">Email Address:</div> <div class="sfs-input-wrapper"><input type="text" name="email" id="email" style="width: 200px" /></div> </label> <label> <div class="sfs-input-title">Phone Number:</div> <div class="sfs-input-wrapper"><input type="text" name="phone" id="phone" style="width: 200px" /></div> </label> <label> <div class="sfs-input-title"> Property Zip Code: </div> <div class="sfs-input-wrapper"><input type="text" name="zip" id="zip" style="width: 200px" /></div> </label> <p> <strong><em>Enter the zip 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