Step 1 - Personal Details
You will be asked to fill out some
personal information about yourself (Your personal information will
never be used, or sold, for any purpose other than to supply you
with the requested insurance information. You will never receive an
uninvited solicitation from anyone as a result of Massquotes.com 's
service.)
*First
Name:
*Last
Name:
Date
of Birth:
(mm/dd/yyyy)
Day
Phone:
Evening
Phone:
*E-Mail:
Street:
City:
State:
Massachusetts
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Zip:
*The
best way to reach me is:
Daytime Phone
Evening Phone
E-Mail
Postal Mail
Step 2
- Homeowners Insurance Coverages
F ill
out information concerning the coverage of your home, how much
property your dwelling sets on, and so forth. If you have any
questions about what to fill in for each spot, you will be given an
opportunity to address this at the end in the “Comment Section” (in
Step 3).
Note: If you are purchasing a home
and/or are unsure of coverage amounts, the contacting
insurance broker will be happy to review with
you.
A)
Dwelling Amount:
B)
Other Structures:
C)
Personal Property:
D)
Loss of Use:
E) Personal
Liability:
Select One...
$100,000
$300,000
$500,000
*$1,000,000
F) Medical Payments:
Select One...
$1,000
$2,000
other
Step 3
- Additional
Info
Fill out additional information about your home and occupants thereof.
It is that simple. When you have completed this form, simply submit it
and a qualified insurance agent will be in touch soon. Getting Massachusetts homeowners insurance quotes can be that simple with Massquotes.com.
Have
you ever been cancelled or non-renewed for homeowner insurance?
No
---
Yes
Any
losses past 3 years?
No
---
Yes
What kind ?
Current
Company:
Renewal Date:
(mm/dd/yyyy)
Year
Built:
(yyyy)
How
many Families?
Owner
Occupied?
Yes
No
Scheduled
Property :
Type:
Amount:
Have you done renovations
to the...?
If so, when?
Plumbing
Heating
Electrical/Wiring
(mm/dd/yyyy)
Replacement
Cost :
Select One...
Dwelling
Personal Property
Both
None
Deductible:
($250, $500,
$1,000 or other?)
Security System?
Burglar
Fire
Smoke
All
None
If so, what kind?
Select One...
Local
Central
Both
Additional
Comments or Information:
YES! I would like to receive a free,
personalized Homeowners Insurance Quote from MassQuotes.com.
Thank you for your information. A professional,
independent, full service insurance broker will be in touch with you when
and where you requested.
©
2002 Massquotes.com