Homeowners Quote Request

Homeowner’s, Renters & Condo Insurance Policy Quote

Robert J Russell - Broker, Owner We only quote A+ and A Rated Companies!
Name(s) of Homeowner(s) *
Occupation *
Date of Birth *
Spouse Date of Birth *
E-mail address *
Method of communication *

Phone Email
Phone Number 1 *

Area Code Phone Number
Phone Number 2

Area Code Phone Number
Address of dwelling needing insurance *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Insured Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long at this address? *
Date of Purchase

Month Day Year
Purchase Price
Projected Closing Date

Month Day Year
Amount of Coverage Requested *
Mortgage Company
Distance to Fire Hydrant
How far from Ocean?
Year Built *
Total Heated Sq. Footage *
Nomber of Stories *
Garage?

Yes No
If Yes:

Attached Detached
How many cars can fit in the garage ?
Construction of Home or Condo
% Frame
% Brick
% Stone
Other. Please Explain
Type of Roof? *

Shingle Composition Metal
Age of the Roof *
Foundation of Home or Condo

Stone Slab Poured Concrete
Central Air?

Yes No
Type of Heat

Gas-Forced air Electric Boiler Propane Hot Water Heat
Year of Construction *
Monitored Alarm system?

Yes No
Swimming Pool?

yes No
If Yes:

In-ground Above-ground
Dog(s) on Premises?

Yes No
If Yes, Breed(s)
Claim history in the last three years
What Insurance Companies are you currently with:
Auto *
Life *
Health
Disability
If any claims in the prior 3 years, please explain *
Do you live here or use it as a rental property? *
Upload your declarations page so that we can compare (Optional but helpful)
How did you hear about us?
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Homeowner’s, Renters & Condo Insurance Policy Quote