Our Specialties:
We specialize in hard to place Homeowners and Tenant Occupied policies. Within an hour we will find a coverage even if the house.

• Built before 1915
• Has galvanized plumbing
• Roof 20 years and older
• Had Fire and Water claims

Personal Home Questionnaire

Address of Property

First Name: Last Name: Street/PO Box: City: State: Zip: Telephone: Email: Fax: Best way to Reach: --- Select item --- Home Phone Business Phone Email When would you like your coverage to begin? When is/was the closing date for your home? Is mailing address the same? --- Select item --- Yes No Type of Residence? --- Select item --- Single Family Home Duplex Triplex Condominium Cooperative Apartment Type of Residence? --- Select item --- Primary Seasonal Secondary Use --- Select item --- Vacation Home Rented to Others Tenant Building's square footage: Age of the building: How many families: Construction Type: --- Select item --- Frame Masonry Other Foundation type: --- Select item --- Basement Crawl Space Slab Stilt-Raised Other Garage Size --- Select item --- None 1 Car 2 Cars 3 Cars 4 Cars More then 4 Garage Type: --- Select item --- None Attached Detached Basement Car Port Year Roof was updated: Year Plumbing was updated Year Heating was updated Year Wiring was updated The plumbing is --- Select item --- Copper Galvanized Type of roof Circuit Breakers --- Select item --- Yes No Any Dogs? If yes, what breed:

Limits of Insurance Required

Liability: --- Select item --- 100,000 300,000 500,000 1,000,000 Dwelling Limit: Personal Property Limit Loss of Use Limit

Previous Insurance History

Current Insurance: Yes No If yes: Insurance Company Expiration Date Premium paid last year: I need coverage: --- Select item --- ASAP Next Week Next Month I am shopping How did you hear about us?