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Massachusetts Renter's Insurance Quote Form
Renters Insurance Quote
Full Name:
Street Address:
City, State & Zip:
Evening Telephone:
Daytime Telephone:
Fax:
E-Mail Address:
Your occupation:
Best Time To Reach You:
Select
Mornings
Afternoons
Evenings
Weekends
Anytime
Date of Birth:
Current Insurance Information
Insurance Company Name:
(
NOT
Insurance Agency/Broker)
Policy Exp. Date:
$ Contents Insured for:
Current Ded:
Premium Amt:
Policy Term:
General Information
Will you or do you live on this property:
yes
no
How much coverage do you want on your personal property($):
How much personal liability:
$100,000
$300,000
$500,000
$1,000,000
Deductible:
$500
$750
$1,000
$2,000
Number of Units:
Number of Stories:
Is there a 24-hour door man:
yes
no
Are there elevators:
yes
no
Year Built(yyyy):
Approximate Square Feet:
Have you reported any claims or losses to your insurance company within the last 5 years
yes
no
Type of Construction:
brick
wood frame
cinder block
other
Roof Type:
composite shingle
tile
wood shingle
other
Roof Age(years - if unknown, please indicate):
Burglar Alarm:
yes
no
Heating System:
forced air
electric
boiler
oil
propane
Number of gas or wood fireplaces or stoves:
What floor do you live on:
Number of bathrooms:
Additional Information
Any business conducted in home: (if yes, please describe)
yes
no
List values of any jewelry, furs, or specialty items:
List pets & breeds:
Additional Comments
No coverage of any kind is bound or implied by submitting information via this online form
Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
We will not distribute information to other parties other than for
insurance underwriting purposes.
By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.