A
963 Eastern Ave. Malden, MA 02148 | Office: 781-322-2350 | Fax: 781-322-3093
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Homeowners Insurance Quote Request
HOMEOWNER QUOTE
No coverage is bound until you are contacted by one of our representatives
CONTACT INFORMATION
Name
Email
Street Address
Street Address
City, State, Zip
Phone Number
Home
Work
HOME LOCATION
Street Address
Street Address
City, State, Zip
RATING INFORMATION
1. What year was this home built?
2. What type of construction was used?
Frame
Masonry
Aluminum Siding
3. What style is your home?
Sgl Family Dwelling
Apartment Building
Condominium
4. How will your home be used?
Primary Residence
Secondary Residence
Seasonal Home
Farm
Unoccupied
Vacant
5. How many rooms in your home?
6. How many full bathrooms in your home?
7. How many 3/4 bathrooms in your home?
8. How many 1/2 bathrooms in your home?
9. How many square feet on the first floor?
10. What type of home do you have?
Single story
Two story
Split entry
Tri-Level
11. How many
total
square feet in your home?
12. Do you have a fireplace?
Yes
No
If yes, please describe what type
13. Do you have a woodstove?
Yes
No
If yes, please describe type and use
14. Do you have a garage?
Yes
No
If yes, please describe what type
Attached single car
Attached two car
Attached three car
Detached single car
Detached two car
Detached three car
Carport
15. What is your primary source of heat?
16. What is your secondary source of heat?
17. Do you have a security system?
Yes
No
If yes, please describe what type
18. Have you had any losses in the past 3 years?
Yes
No
If yes, please describe
19. Is this your first home?
Yes
No
If no, do you have current insurance?
Yes
No
20. Do you own any pets?
Yes
No
If yes, Please describe
COVERAGE INFORMATION
1. Do you want earthquake coverage?
Yes
No
2. Do you have collections worth over $500?
Yes
No
If yes, Please describe
3. Do you have any single piece of jewelry valued over $500?
Yes
No
If yes, Please describe
4. Do you have work tools that need coverage?
Yes
No
If yes, Please describe
5. Do you operate a business out of your home?
Yes
No
If yes, Please describe
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