10/15/2008 03:48:50 PM
192 Worcester Street (Rt 9)
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Wellesley Hills, MA 02481
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Tel. (800) 696-2901
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Fax
781-237-3069
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Get a quote for Massachusetts Renter's Insurance
Renter's Insurance Quote Request
No coverage is bound until you are contacted by someone from our staff
CONTACT INFORMATION
Name
Email
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
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10/15/2008 03:48:50 PM
10/15/2008 03:48:50 PM
