Homeowner Insurance

To learn more about Homeowner Insurance please contact one of our fine Customer Service Representatives by email or at 978 365-2302.

Homeowner Insurance

Quote

First Name:

Last Name:

*Address:

City:

State:

Zip:

Year Built:

Number of Stories:

What is the style of your home?:

	Ranch		Town House
	Cape Cod		Bi-Level
	Colonial		Split Level
	Bungalow		Raised Ranch
	Victorian		Contemporary

Total living area square footage?:

Do you have a basement?: Yes No

If yes, is it finished? On a slab? Crawl space?

Exterior Wall Type:

Roof Material:

Attached Structures:

Please check off any items that are in your home:

	Single Fireplace		Jacuzzi
	Double Fireplace		Hot Tub
	Wood Stove		Wet Bar

Kitchen Classification:

Builder’s grade

Custom (granite, center island etc.)

Please indicate # of bathrooms by type:

Full (tub/shower, sink, toilet)

Half (sink, toilet)

Other:

Type of Heat:

Central A/C Separate Ducts

Miscellaneous:

Fire Alarm System

Burglar Alarm System

When did you purchase your home?:

What is your current insurance company?:

Have you had your insurance declined, cancelled or non-renewed in the last 3 years? If yes, was there a period of time when you had no insurance?:

Please answer the questions below, be specific where applicable.

Have you had any property liability losses in the last 5 years?:

Do you own the residence?:

Do you have any exotic pets?
If yes, please specify.:

Do you own any recreational vehicles (snowmobiles, dune buggy, mini bikes, ATV's, etc)?
If yes, please specify.:

Is the house undergoing renovation or reconstruction?:

Is the house for sale?:

Do you have a trampoline?:

Do you have a swimming pool?:

	Above Ground		In Ground
	Fenced		Slide
	Diving Board		Stairs

What is the best time to contact you?:

Preferred Contact Method (Please specify and provide contact info):

Email Phone Fax
Email:
Phone#
Fax #

Disclaimer Notice Your request for a premium quotation will be an estimate based on this information, and coverage cannot be bound with your quote request. In order for Kerrigan, O’Malley & Bailey Insurance Agency to bind coverage, a completed application signed by you along with a down payment of premium must be received prior to the effective date.