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Homeowners Insurance - Online Quote Form

Please complete the following form and click the "Send Quote" button to submit for a free Homeowners quote. Quote is subject to verification of information and inspection. Additional information may be requested.

Disclaimer - Please note, these quotes are computed to the best of our ability with the information provided. If the information provided is incomplete or incorrect, your actual quote may change. Thank You.

 

Name *   Birthdate   
SSN*
Address
City State Zip
County
Phone Fax
E-Mail *
Previous Address (if less than 3 years)
How would you like to be contacted?


Home Description

Construction Brick Frame
Year Built
Purchase Price
Mortgage Amount
What is the style of your home? Ranch
Cape Cod
Colonial
Bungalow
Victorian
Town House
Bi-Level
Split Level
Raised Ranch
Contemporary

 

 

 

 

 

 

 

 

Please advise the date the following items have been updated if home is over 20 years old:
Plumbing
Heating
Electrical
Roof

 

Is your home within 3 miles from a Fire Station? Yes No
Is your home within 500 feet from a Fire Hydrant? Yes No
Do you have smoke detectors? Yes No
Do you have fire extinguishers? Yes No
Are you a non-smoker? Yes No
If you own autos, would you be interested in combining the autos with the homeowners policy for additional discounts? Yes No
Auto Carrier

Coverage Limits

Dwelling
Contents
Liability
Deductible

List any items which you desire to have scheduled for an agreed amount , i.e. Jewelry, Furs, Silverware:

General Information
Have you had any homeowner claims or losses within the last 3 years? Yes No
Claim Dates
Amount(s) paid to you in a claim
Present Carrier Non-Renewing? Yes No
If yes, Reason:

 
Do you have a wood stove? Yes No
Do you own a dog? Yes No What type?
Do you have a swimming pool? Yes No
If so, is the pool completely fenced in? Yes No
Do you have a Trampoline? Yes No

 
Current policy expiration date? Insurance Carrier

Any Additional Comments:

* Insurance companies are now requiring the use of credit reports and claims scores in order to place business.  By completing and submitting this quote request form you are authorizing McSweeney & Ricci to run your credit and claim score reports.

 



 

 

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