NEIGHBORHOOD INSURANCE

HOMEOWNER'S INSURANCE QUOTE

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In order to receive the most accurate quote, please answer the following questions as best you can.

Coverage can only be calculated after receiving this quote.

FOLLOWING THE PROCEDURES OF OTHER INSURANCE COMPANIES YOU MAY BE SUBJECT TO

A CREDIT SCORING CHECK WITH MERCHANTS INSURANCE

* indicates required fields  

Name
Address
Residing Town/City
Residing State
E-mail
Phone
Fax
Type of policy Homeowners Condo/townhouse Renters
Number of families Single Two Family/Duplex 3 or 4 Family
Prefer free quote returned by? Email           Phone
Please choose your deductible: The higher the deductible, the less your policy will cost.  
 
 
RENTERS/CONDO OWNERS property  
Please choose your personal property limit:  
 
Dwelling Replacement Amount (homes only)
Please state if you have a dwelling replacement amount on which you want us to quote. Otherwise we will take the information you provide below to provide a dwelling coverage limit.
Desired dwelling replacement
amount (Coverage "A"):
How many floors: One         Two         Two 1/2         Three
   
Square Footage: (total living space) if available OR check below
  I do not know. The above footage represents TOTAL square footage.
Year constructed: Pre-1940 Pre-1980 After 1980 New
Exterior: Framed (clapboard, asbestos, etc)
Aluminum/Vinyl Siding
Masonry Veneer (Stucco)
Masonry
Distance from ocean: Not sure Shoreline Less than 500 ft 500 to 1499 ft 1500 ft+
If flood insurance is required: Yes         No   (If yes will be in contact for more details)
Garage: 
 None  One car attached Two car attached  One/two car basement
Heating Source: Oil     Gas    Electric
If older home, state updates
in the last 20 years		 No updates done
Roof  year updated
Plumbing  year updated
Electric  year updated
Heating  year updated
Electric Details: Circuit Breakers     Fuses
Number of amps: 100amps                 200amps
Central Air ? None     Existing ducts     Separate ducts
Wood Stove ? Yes        No  (if yes) 
 
Check boxes that apply. 		Complete answers will allow us to include proper coverage and discounts:
Guaranteed replacement on contents
Guaranteed replacement on dwelling
Fireplace
Deck (s)
Porch (es)
 In-home business
Burglar alarm
Smoke alarm system
Sprinkler system
Deadbolts
Other properties owned
 Home computer
Any Dogs ? Yes     No    (if yes please specify) 
Swimming Pools ? Yes     No (if yes please specify below)
What is the depth:
Diving Board ? Yes     No
Pool Slide ? Yes     No
Would you like to add  earthquake coverage? Yes     No

If you have any questions regarding some of the terminology in the form please click the link below before submitting the form.

Click Here

Please click the "Submit" button below. We will have an Auto quote for you in approximately 2-10 business days. If you have any questions or comments please feel free to contact us at the following number listed below:

 (508) 528-5100 or (508) 528-9700

Thank You for taking time to fill out this form.