<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/rtl.html -->

    
<!-- Locale=en_US_ISO8859_1 -->

    
<!-- EOF: ./personal-templates/rtl.html -->


<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


<!-- EOF: ./personal-templates/simple/generic/functions -->


<!-- EOF: ./personal-templates/simple/generic/show -->

<!-- BOF: ./personal-templates/simple/generic/images -->

<!-- EOF: ./personal-templates/simple/generic/images -->


<!-- BOF: ./personal-templates/simple/personal/other/l52.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l52.settings.init -->


  <!-- BOF: ./personal-templates/simple/business/layout/l58.wait -->


<!-- EOF: ./personal-templates/simple/business/layout/l58.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="Auto Insurance, Homeowners' & Renters' Insurance, Insurance, Life Insurance, Corporate Insurance Adjusters ">
<META NAME="Keywords"    CONTENT="Auto Insurance, Homeowners' & Renters' Insurance, Insurance, Life Insurance, Corporate Insurance Adjusters ">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://www.americaninsuringgroup.com/form.html">-->
<TITLE>Home Quote</TITLE></head>
<BODY  BGCOLOR="#DDE1E4"
 TEXT="#000000"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#000000"
 ALINK="#FF3C00"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l58.layout --> 

<!-- html -->
<TABLE DIR="LTR" WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" BGCOLOR="#84929F" BACKGROUND="widgets/gen_495.1.gif" style="background-attachment: fixed; background-position: 0% 100%;background-repeat: repeat-x;">
    <TR>
        <TD WIDTH="100%" HEIGHT="100%" ALIGN="center" VALIGN="top" BACKGROUND="widgets/gen_494.1.gif" style="background-attachment: fixed; background-position: 0% 0%;background-repeat: repeat-x;">    
            <TABLE WIDTH=775 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                <TR>
                    <TD WIDTH="100%" HEIGHT=105>
                        <TABLE WIDTH="100%" HEIGHT=105 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=688 HEIGHT=105>
                                    <img src="widgets/gen_549.1.gif" border=0 width=688 height=105 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=105 BACKGROUND="widgets/gen_497.1.gif">
                                    <img src="widgets/spacer.gif" height=105 width=6 alt=""></TD>
                                <TD WIDTH=81 HEIGHT=105>
                                    <img src="widgets/gen_498.1.gif" border=0 width=81 height=105 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" HEIGHT=1 VALIGN="top">
                        <TABLE WIDTH="100%" HEIGHT=1 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=32 HEIGHT=1 VALIGN="top">    
                                    <img src="widgets/gen_499.1.gif" border=0 width=32 height=1 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=1 BGCOLOR="#27333F">
                                    <img src="widgets/spacer.gif" height=1 width=6 alt=""></TD>
                                <TD WIDTH=24 HEIGHT=1 VALIGN="top">    
                                    <img src="widgets/gen_500.1.gif" border=0 width=24 height=1 alt=""></TD>
                            </TR>
                            <TR>
                                <TD WIDTH=32 HEIGHT=19 VALIGN="top" BACKGROUND="widgets/gen_501.1.gif">    
                                    <img src="widgets/gen_501.1.gif" border=0 width=32 height=19 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=19 BGCOLOR="#27333F" BACKGROUND="widgets/gen_503.1.gif" style="background-attachment: fixed; background-position: 0% 0%;background-repeat: repeat-x;">
                                    
                                    <a href="index.html" onMouseOver="document.images['img6'].src='widgets/gen_675.1.gif'" onMouseOut="document.images['img6'].src='widgets/gen_673.1.gif'"><img src="widgets/gen_673.1.gif" alt="Company Profile" name="img6" border="0"></a>
                                    <a href="gpage.html1.html" onMouseOver="document.images['img27'].src='widgets/gen_671.1.gif'" onMouseOut="document.images['img27'].src='widgets/gen_670.1.gif'"><img src="widgets/gen_670.1.gif" alt="Meet Our Staff" name="img27" border="0"></a>
                                    <a href="gpage.html3.html" onMouseOver="document.images['img114'].src='widgets/gen_705.1.gif'" onMouseOut="document.images['img114'].src='widgets/gen_704.1.gif'"><img src="widgets/gen_704.1.gif" alt="Accident/Claim Reporting" name="img114" border="0"></a>
                                    <a href="gpage.html" onMouseOver="document.images['img8'].src='widgets/gen_702.1.gif'" onMouseOut="document.images['img8'].src='widgets/gen_701.1.gif'"><img src="widgets/gen_701.1.gif" alt="Companies We Represent" name="img8" border="0"></a>
                                    <a href="gpage3.html" onMouseOver="document.images['img22'].src='widgets/gen_553.1.gif'" onMouseOut="document.images['img22'].src='widgets/gen_552.1.gif'"><img src="widgets/gen_552.1.gif" alt="Business Services" name="img22" border="0"></a>
                                    <a href="gpage2.html" onMouseOver="document.images['img13'].src='widgets/gen_555.1.gif'" onMouseOut="document.images['img13'].src='widgets/gen_554.1.gif'"><img src="widgets/gen_554.1.gif" alt="Personal Services" name="img13" border="0"></a>
                                    
                                    
                                    <a href="gpage.html2.html" onMouseOver="document.images['img48'].src='widgets/gen_677.1.gif'" onMouseOut="document.images['img48'].src='widgets/gen_676.1.gif'"><img src="widgets/gen_676.1.gif" alt="Privacy Notice" name="img48" border="0"></a>
                                    <a href="form1.html" onMouseOver="document.images['img54'].src='widgets/gen_683.1.gif'" onMouseOut="document.images['img54'].src='widgets/gen_682.1.gif'"><img src="widgets/gen_682.1.gif" alt="Auto Quote" name="img54" border="0"></a>
                                    <a href="form.html" onMouseOver="document.images['img66'].src='widgets/gen_685.1.gif'" onMouseOut="document.images['img66'].src='widgets/gen_684.1.gif'"><img src="widgets/gen_684.1.gif" alt="Home Quote" name="img66" border="0"></a>
                                    <a href="form1bq.html" onMouseOver="document.images['img77'].src='widgets/gen_691.1.gif'" onMouseOut="document.images['img77'].src='widgets/gen_690.1.gif'"><img src="widgets/gen_690.1.gif" alt="Business Quote" name="img77" border="0"></a>
                                    <a href="form1hlq.html" onMouseOver="document.images['img95'].src='widgets/gen_694.1.gif'" onMouseOut="document.images['img95'].src='widgets/gen_693.1.gif'"><img src="widgets/gen_693.1.gif" alt="Health/Life Quote" name="img95" border="0"></a>
                                    
                                    <a href="sitemap.html" onMouseOver="document.images['img26'].src='widgets/gen_665.1.gif'" onMouseOut="document.images['img26'].src='widgets/gen_664.1.gif'"><img src="widgets/gen_664.1.gif" alt="Site Map" name="img26" border="0"></a>
                                    
                                    <a href="mailto:david@americaninsuringgroup.com" onMouseOver="document.images['img_email'].src='widgets/gen_548.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_547.1.gif'"><img src="widgets/gen_547.1.gif" alt="e-mail me" name="img_email" border="0"></a></TD>
                                <TD WIDTH=24 HEIGHT=19 VALIGN="top" BACKGROUND="widgets/gen_502.1.gif">        
                                    <img src="widgets/gen_502.1.gif" border=0 width=24 height=19 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" HEIGHT=9 VALIGN="top">
                        <TABLE WIDTH="100%" HEIGHT=9 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=49 HEIGHT=9 VALIGN="top">    
                                    <img src="widgets/gen_504.1.gif" border=0 width=49 height=9 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=9 BGCOLOR="#27333F" BACKGROUND="widgets/gen_506.1.gif">
                                    <img src="widgets/spacer.gif" height=1 width=6 alt=""></TD>
                                <TD WIDTH=42 HEIGHT=9 VALIGN="top">    
                                    <img src="widgets/gen_505.1.gif" border=0 width=42 height=9 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" HEIGHT=172 VALIGN="top">
                        <TABLE WIDTH="100%" HEIGHT=172 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=283 HEIGHT=172>
                                    <img src="widgets/gen_507.1.gif" border=0 width=283 height=172 alt=""></TD>
                                <TD WIDTH="50%" HEIGHT=1 BGCOLOR="#FFFFFF">
                                    <img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
                                <TD WIDTH=215 HEIGHT=172>
                                    <img src="widgets/gen_508.1.gif" border=0 width=215 height=172 alt=""></TD>
                                <TD WIDTH="50%" HEIGHT=1 BGCOLOR="#FFFFFF">
                                    <img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>
                                <TD WIDTH=275 HEIGHT=172 >
                                    <img src="widgets/gen_509.1.gif" border=0 width=275 height=172 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" HEIGHT=29 VALIGN="top">
                        <TABLE WIDTH="100%" HEIGHT=29 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=775 HEIGHT=29>
                                    <img src="widgets/gen_510.1.gif" border=0 width=707 height=29 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=29 BACKGROUND="widgets/gen_511.1.gif">
                                    <img src="widgets/spacer.gif" height=29 width=17 alt=""></TD>
                                <TD WIDTH=51 HEIGHT=29>
                                    <img src="widgets/gen_512.1.gif" border=0 width=51 height=29 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH=775 HEIGHT="100%" VALIGN="top">
                        <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=35 HEIGHT=4>
                                    <img src="widgets/gen_513.1.gif" border=0 width=35 height=4 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=4 BACKGROUND="widgets/gen_528.1.gif">
                                    <img src="widgets/spacer.gif" height=4 width=4 alt=""></TD>
                                <TD WIDTH=29 HEIGHT=4>
                                    <img src="widgets/gen_514.1.gif" border=0 width=29 height=4 alt=""></TD>
                            </TR>
                            <TR>
                                <TD WIDTH=35 HEIGHT="100%" VALIGN="bottom" BACKGROUND="widgets/gen_515.1.gif">
                                    <img src="widgets/gen_517.1.gif" border=0 width=35 height=171 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT="100%" BGCOLOR="#DDE1E4">
                                    <!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#0276D0'>

Home Quote

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
function validate(frm){
var i = 0;

if (frm.field_70.value=="") return error(frm.field_70);

if (frm.field_72.value=="") return error(frm.field_72);

return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://sitestudio.websitewelcome.com:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Home Quote">
<input type="hidden" name="efrom" value="">
<input type="hidden" name="email" value="david@americaninsuringgroup.com">
<input type="hidden" name="esubj" value="Submitted Form Report">
<input type="hidden" name="submit_url" value="onsubmit2.html">
<input type="hidden" name="error_url"  value="onerror2.html">
<input type="hidden" name="order" value="70 71 72 73 74 75 76 92 ">
<script>
var p = location.pathname;
if (p.charAt(p.length)!='/') {
    p = p.substring(0, p.lastIndexOf('/')+1);
}
document.forms[0].domain.value = location.protocol+'//'+location.host+p;
</script>
<table border=0 cellpedding=5 cellspacing=5>

<input type="hidden" name="name_70" value="Name">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Name

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_70" style="width:100%">


</td></tr>

<input type="hidden" name="name_71" value="Address/Telephone">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Address/Telephone

</font>


 </td><td>


<textarea name="field_71" rows="4" cols="30"></textarea>

</td></tr>

<input type="hidden" name="name_72" value="E-mail">
<tr><td>


<font face='Arial' size='2' color='#000000'>

E-mail

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_72" style="width:100%">
<input type="hidden" name="rcpt" value="field_72">


</td></tr>

<input type="hidden" name="name_73" value="Home Info: Age">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Home Info: Age

</font>


 </td><td>


<input type="text" name="field_73" style="width:100%">


</td></tr>

<input type="hidden" name="name_74" value="Square Footage/ # of Stories">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Square Footage/ # of Stories

</font>


 </td><td>


<textarea name="field_74" rows="4" cols="30"></textarea>

</td></tr>

<input type="hidden" name="name_75" value="Current Insured Values: Home">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Current Insured Values: Home

</font>


 </td><td>


<input type="text" name="field_75" style="width:100%">


</td></tr>

<input type="hidden" name="name_76" value="Personal Property">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Personal Property

</font>


 </td><td>


<input type="text" name="field_76" style="width:100%">


</td></tr>

<input type="hidden" name="name_92" value="Comments">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Comments

</font>


 </td><td>


<textarea name="field_92" rows="4" cols="30"></textarea>

</td></tr>

<tr><td colspan=2 align=center>
    <input onClick="return validate(form)" type="submit" value="Submit">
    <input type="reset"  value="Reset">
    </td>
</tr>
</table>
</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
</TD>
                                <TD WIDTH=29 HEIGHT="100%" VALIGN="bottom" BACKGROUND="widgets/gen_516.1.gif">
                                    <img src="widgets/spacer.gif" height=4 width=29 alt=""></TD>
                            </TR>
                            <TR>
                                <TD WIDTH=35 HEIGHT=6>
                                    <img src="widgets/gen_518.1.gif" border=0 width=35 height=6 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=6 BGCOLOR="#DDE1E4" BACKGROUND="widgets/gen_529.1.gif">
                                    <img src="widgets/spacer.gif" height=6 width=6 alt=""></TD>
                                <TD WIDTH=29 HEIGHT=6>
                                    <img src="widgets/gen_519.1.gif" border=0 width=29 height=6 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" VALIGN="top">
                        <TABLE WIDTH="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=34 HEIGHT=8 VALIGN="top">
                                    <img src="widgets/gen_520.1.gif" border=0 width=34 height=8 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=8 VALIGN="top" BACKGROUND="widgets/gen_522.1.gif">
                                    <img src="widgets/spacer.gif" height=8 width=6 alt=""></TD>
                                <TD WIDTH=28 HEIGHT=8 VALIGN="top">
                                    <img src="widgets/gen_521.1.gif" border=0 width=28 height=8 alt=""></TD>
                            </TR>
                            <TR>
                                <TD WIDTH=34 HEIGHT="100%" VALIGN="top" BACKGROUND="widgets/gen_523.1.gif">
                                    <img src="widgets/spacer.gif" height=3 width=34 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT="100%" VALIGN="top" BACKGROUND="widgets/gen_530.1.gif">
                                    

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Company Profile</A>|</nobr>

<nobr>|<a href="gpage.html1.html">Meet Our Staff</A>|</nobr>

<nobr>|<a href="gpage.html3.html">Accident/Claim Reporting</A>|</nobr>

<nobr>|<a href="gpage.html">Companies We Represent</A>|</nobr>

<nobr>|<a href="gpage3.html">Business Services</A>|</nobr>

<nobr>|<a href="gpage2.html">Personal Services</A>|</nobr>

<nobr>|<a href="gpage.html2.html">Privacy Notice</A>|</nobr>

<nobr>|<a href="form1.html">Auto Quote</A>|</nobr>

<nobr>|Home Quote|</nobr>

<nobr>|<a href="form1bq.html">Business Quote</A>|</nobr>

<nobr>|<a href="form1hlq.html">Health/Life Quote</A>|</nobr>

<nobr>|<a href="sitemap.html">Site Map</A>|</nobr>
</center>
</font>

<br>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</TD>
                                <TD WIDTH=28 HEIGHT="100%" VALIGN="top" BACKGROUND="widgets/gen_524.1.gif">
                                    <img src="widgets/spacer.gif" height=3 width=28 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" HEIGHT=67 VALIGN="top">
                        <TABLE WIDTH="100%" HEIGHT=67 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                            <TR>
                                <TD WIDTH=99 HEIGHT=67 VALIGN="top">
                                    <img src="widgets/gen_525.1.gif" border=0 width=99 height=67 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT=8 VALIGN="top" BACKGROUND="widgets/gen_527.1.gif">
                                    <img src="widgets/spacer.gif" height=67 width=6 alt=""></TD>
                                <TD WIDTH=49 HEIGHT=67 VALIGN="top">
                                    <img src="widgets/gen_526.1.gif" border=0 width=49 height=67 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
            </TABLE>
        </TD>
    </TR>
</TABLE>
<!-- end html -->
                
<!-- EOF: ./personal-templates/simple/business/layout/l58.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


<!-- EOF: ./personal-templates/show.body -->