845-Insurance.com

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845-Insurance.com
39 Maple Ave.
New City, NY 10956
(845) 638-6200
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Condominum & Co-op Insurance Quote Request

Name
Current Address
Day Time Phone
Evening Phone
Email Address
Occupation
Date of Birth
Address of Property (if different)
Purchase Date
Purchase Price
Number of Occupants
Current Loan Amount
Currently Insured	Yes No
Current Company
Current Expiration Date
Claims in the last 5 years	Yes No
If Yes, Year of Loss
Interior Structure Coverage
Personal Contents Coverage
Self Described Credit History	Excellent Average Poor
Type of Ownership	Condo Coop
Occupancy	Primary Residence Seasonal Residence Tenant Occupied Vacant
Year Built
Exterior Walls	Frame Brick Brick Veneer
Wood Burning Stove	Yes No
Number of units in the building	One 2-10 10+
Dog	Yes No
If Yes, Dog Breed
Liability limits	100K 300K 500K 1,000,000
Business on Premesis	Yes No
Deductible	250 500 1000
Multi Policy Discount (For Insuring Your Auto’s as Well)	Yes No
Preferred Contact Time	Morning Afternoon Evening Anytime
Comments:
You may be contacted to verify additional information. For everyone’s courtesy please only submit serious requests.