11/20/2008 08:12:28 AM
138 River Road
Suite 306
Andover, MA 01810
Tel: 978-682-9633
Fax: 978-681-0623
Toll Free: 1-888-430-6200
Automobile Insurance
Whether for business or personal use we have the most competitive auto insurance programs around.
Business Insurance
We offer commercial insurance programs for businesses of all sizes.
Home and Life Insurance
Home, Life, Watercraft, Renters, Insurance and more.....
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Get a quote for Massachusetts Renter's Insurance
Request Quote for Renters Insurance.
Renter's Insurance Quote Request
No coverage is bound until you are contacted by someone from our staff
CONTACT INFORMATION
Name
Street Address
Street Address/Apt #
City, State, Zip
Phone Number
Home
Work
RATING INFORMATION
1. What year was this dwelling built?
2. What type of dwelling?
Single Family Home
Duplex
Mobile Home
Apartment
Condo
Townhouse
Other
3. What type of construction?
Frame
Masonry
Aluminum Siding
4. Do you have a fireplace?
Yes
No
If yes, please describe what type
5. Do you have a woodstove?
Yes
No
6. What is the primary source of heat?
7. What is the secondary source of heat?
8. Do you have a security system?
Yes
No
If yes, please describe what type
9. Have you had any losses in the past 3 years?
Yes
No
If yes, please describe
10. Do you have renters insurance now?
Yes
No
11. Do you own any pets?
Yes
No
If yes, Please describe
COVERAGE INFORMATION
1. What is the total value of your personal property?
$
2
. Do you want earthquake coverage?
Yes
No
3. Do you have collections worth over $500?
Yes
No
If yes, Please describe
4. Do you have any single piece(s) of jewelry valued over $500?
Yes
No
If yes, Please describe
5. Do you have work tools that need coverage?
Yes
No
If yes, Please describe
6. Do you operate a business out of your residence?
Yes
No
If yes, Please describe
By completing and submitting this form you agree that no coverage is bound and no policy is in effect until you are contacted by one of our representatives. All information submitted is held in the strictest confidence and is only gathered for the purposes of providing you an insurance quote. To provide the most accurate quote possible please complete all areas that apply.
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