HOMEOWNERS

INSURANCE

QUOTE

 

 

We would like to provide you with a free, no-obligation homeowners insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

This is not an application for insurance, and it does not obligate this agency to issue any policy of insurance.

Despite the security measures taken, there are inherent risks of disclosing personal info on the website. If you are concerned, please feel free to call, fax, or mail at your convenience.

 

Personal Information
Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:
Occupation:   How Long At Current Job:


Current Homeowners Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
Amount Insured For: $     Policy Type: Primary Secondary
Term: 6 Months   1 Year   Other:


Home Information
How Long At Present Address:     Year Home Was Built:
Sq. Footage (excluding garage
and basement):
sq. ft.         # of Claims In Last 3 Years:


Structure Information
Type
Construction
Roof
Foundation
Garage
Age of roof: yrs.


Features
Bathrooms
Basement
Deck/Porch/Patio
Fireplaces
# of Full:
# of Half:

Sq. Ft.:
Deck Sq. Ft.:    
Porch Sq. Ft.:    
Screened Patio Sq. Ft.:    
# of Chimneys:    
# of Hearths:    


Additional Features
Heating System
Central Air
Central Vac
Security Alarm
Fire Alarm
Smoke Detector
Yes
Yes
Yes
Trampoline
Swimming Pool
Do You Own a Dog?
Yes/No
Breed
Biting History
Yes
Above
Ground
Below
Ground
Yes


Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   


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HEDLEY BROOK AGENCY, INC.
818 W. State Street, P.O.B. 585, Olean, New York 14760-0585 USA
Tel: 716-372-1122 · Fax: 716-372-1143
TOLL FREE (NY-PA-FL) 1-877-414-1122
info@hedleybrook.com

This is not an offer to sell insurance in any place except the state of NY, USA The Society of Certified Insurance Counselors Trusted Choice Independent Insurance Agent

 

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