Free Homeowner's 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.

Personal Information (*required field)
*Name:
*Address:
*City:   *State:   *Zip:
*Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:
Social Security Number:     Date of Birth:
Occupation:
How Long At Current Job:


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


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


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


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

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


Additional Features
Heating System
Central Air
Central Vac
Security Alarm
Fire Alarm
Smoke Detector
Yes
Yes
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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Free Auto Insurance Quote

We would like to provide you with a free, no-obligation automobile 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.

Personal Information (*required field)
*Name:
*Address:
*City:   *State:   *Zip:
*Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:


Current Auto Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
Term: 6 Months 1 Year Other:


Vehicle Information
(include all cars you or your family members own or lease)
Car
#1
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?   # of miles
  Airbags  
Car Alarm
Y N       one way
Y   N
Y   N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:


Car
#2
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?   # of miles
  Airbags  
Car Alarm
Y N       one way
Y   N
Y   N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:


Car
#3
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?   # of miles
  Airbags  
Car Alarm
Y N       one way
Y   N
Y   N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:


Car
#4
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?   # of miles
  Airbags  
Car Alarm
Y N       one way
Y   N
Y   N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:


Liability Limit For ALL Cars
Choose either   Bodily Injury   and   Property Damage

Bodily Injury
   
Property Damage

or   Single Limit

Single Limit


Deductibles and Misc.
Car#
Comprehensive Deductible
Collision Deductible
Towing
Loss of Use
1
Yes
Yes
2
Yes
Yes
3
Yes
Yes
4
Yes
Yes


Driver Information
(include all licensed drivers in your household)
Driver
#1
Driver's Name
Drivers License Information
DL#: State: Yrs Licensed:
Relation
Date of Birth
Sex
Marital Status
Soc. Sec. #
Courses Completed Last 3 yrs
M
F
M
S
Drivers Ed:  N
Accident Prevention:  N


Driver
#2
Driver's Name
Drivers License Information
DL#: State: Yrs Licensed:
Relation
Date of Birth
Sex
Marital Status
Soc. Sec. #
Courses Completed Last 3 yrs
M
F
M
S
Drivers Ed:  N
Accident Prevention:  N


Driver
#3
Driver's Name
Drivers License Information
DL#: State: Yrs Licensed:
Relation
Date of Birth
Sex
Marital Status
Soc. Sec. #
Courses Completed Last 3 yrs
M
F
M
S
Drivers Ed:  N
Accident Prevention:  N


Driver
#4
Driver's Name
Drivers License Information
DL#: State: Yrs Licensed:
Relation
Date of Birth
Sex
Marital Status
Soc. Sec. #
Courses Completed Last 3 yrs
M
F
M
S
Drivers Ed:  N
Accident Prevention:  N


Driver History
Please list ANY convictions for ANY driver convicted of moving traffic violations in the past 3 years
Driver
Date
Type of Conviction
Fines
Speed Over Limit
$
mph
$
mph
$
mph
$
mph


Please list ANY driver who has had license suspensions, revocations or DUI convictions below
Driver
License Suspended or Revoked
DUI Conviction For:
Suspended   Revoked  
Alcohol   Drugs  
Suspended   Revoked  
Alcohol   Drugs  
Suspended   Revoked  
Alcohol   Drugs  
Suspended   Revoked  
Alcohol   Drugs  


Please list ANY driver involved in accidents, regardless of fault, in the past 5 years
Driver
Date
Description
Cost
Fines
Injuries
At Fault
$
$
Yes
Yes
$
$
Yes
Yes
$
$
Yes
Yes
$
$
Yes
Yes


Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, such as additional drivers, vehicles, driver histories, etc..., 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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Free Boat/Watercraft Insurance Quote

We would like to provide you with a free, no-obligation boat/watercraft 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.

Personal Information (*required field)
*Name:
*Address:
*City:   *State:   *Zip:
*Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:

 

Current Boat/Watercraft Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
Term: 6 Months   1 Year   Other:

 

Coverages
(input only for those desired)
Type
Sums Insured
Type
Sums Insured
Hull- Physical Damage $ Tender / Dinghy $
Liability Coverage $ Crew Liability $
Owner / Operator M&C $ Medical Payments $
Commercial Passenger Liability $ Uninsured Boater $
Trailer $ Personal Property $
Non-Emergency Towing $ Other $

 

Vessel Information
Vessel Name:
Manufacturer/Model:
 
Year
 
Length
Date
Purchased
Purchase
Price
$
Present
Value
$
Max
Speed
mph
 
Registration #
Hull Identification #:
Waters to be navigated:
Tenders or Dinghies:
Storage Address (Street, City, Co., St.):

LAID UP:
From: to
On Shore
Afloat

Stored on Trailer:
Y   N

Will be trailered over 100 miles:
Y   N

 

Equipment
(please select ALL equipment on your Boat/Watercraft)
Bilge Pumps CO2/Halon System Aux Generator, Diesel
EPIRB Fume Detector Aux Generator, Gas
Sonar Fire Extinguishers
Other (list below)
Depth Sounder Cooking Stove
LORAN/ Direction Finder Engine Alarm
GPS Anti-theft Devices
Radar Life Raft
SATNAV/ OMEGA Ship to Shore Radio

 

Miscellaneous
(please check ALL that apply)
Primary Power
Type of Hull
Hull Material
Fuel Tank
Sail Sailboat Wood Metal
Outboard Performance Metal Fiberglass
Inboard Runabout Fiberglass
Inboard/ Outdrive
Other

 

Engine/Outboard Motor Information
(please complete for each engine)
Eng
H.P.
Gas
Diesel
Year
Date
Purchased
Purchase
Price
Present Value
1
$
$
2
$
$
3
$
$
Manufacturer/Model Serial Number
1
2
3

 

Trailer Information
Year
Date Purchased
Purchase Price
$
Present Value
$
Manufacturer/Model:
Serial #:

 

Operators
(always list insured as Operator #1)
 # 
Name
DOB
Auto DL #
State
Social Security #
USCG/Power Squadron
Certificate
1
2
n/a
3
n/a
#
Auto Violations/Suspensions in last 5 years:
Years of Boat Ownership:
1
2
3

 

Boat/Watercraft Usage
 # 
Explain all YES responses in REMARKS
Y/N
 # 
Explain all YES responses in REMARKS
Y/N
1
Is the boat chartered to others with captain? Y
N
6
Is the boat used commercially or for business purposes? Y
N
2
Is the boat chartered to others without
captain?
Y
N
7
Does the applicant employ a paid crew? If so how many? Y
N
3
Is the boat used for racing? Y
N
8
Was any operator involved in a marine loss in the last 10 years (insured or not)? Y
N
4
Is the boat used for water skiing or diving? Y
N
9
Was any coverage declined, cancelled or non-renewed during the last 5 years? Y
N
5
If the boat is used for fare paying passenger charters, what is the average number of passengers
per trip?     Number of trips per year?
REMARKS


Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, such as additional operators, coverages, etc..., 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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Free Collector Car Insurance Quote

We would like to provide you with a free, no-obligation collector car 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.

Click image below for quote:

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Free Flood Insurance Quote

We would like to provide you with a free, no-obligation flood 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.

Personal Information (*required field)
*Name:
*Address:
*City:   *State:   *Zip:
*Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:
Social Security Number:     Date of Birth:
Occupation:
How Long At Current Job:


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


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


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


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

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


Additional Features
Heating System
Central Air
Central Vac
Security Alarm
Fire Alarm
Smoke Detector
Yes
Yes
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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Appointments Made Easy

Would you like to meet with one of our local agents? Scheduling an appointment is as simple as filling out the information below. We will confirm within one business day. You can also call our local office at (718) 885-1050. We are always happy to assist you! Get directions to our office.

 

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