homeowners

Quick Response Form:

Quote processed by a representative within 24 hours

For immediate quotes and coverage explanation call: 1-800-921-1008 Ext 120, Mary Anzalone • Email: manzalone@bfbond.com

Homeowners Insurance Quote Request

Please, fill out the form completely

Complete the following information if you would like to obtain a quote on Homeowners Insurance. Please understand this is not an application for insurance. An application will be sent to you if coverage is desired.
All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

The home may be a single family owner occupied dwelling (home), condo or townhome. This program may provide dwelling fire coverage, contents - personal property, loss of use, separate structures such as a detached garage or shed, premise medical and premise liability insurance.

Complete this form to get a quote on a single family owner occupied home, condo or townhouse.
You can also get a quote on: Rental Property (1-4 units), Mobilehome, Apartment Building 5+units)

Personal Information

Applicant Name

Phone Number

Fax Number

Date of Birth

Email

Mailing Address

State

Is Property Address same as Mailing Address?

Yes No

Property Address

State

What is the dwelling use?

What year was it built?

Purchased Date?

Construction Type

# of Stories

Total Sq. Ft. of building

Type of Roof

Was the Roof Updated?

Yes No

What year?

Does the building have a pool?

Yes No

Is the pool fenced?

Yes No

Does the pool have a diving board?

Yes No

Does the pool have a slide?

Yes No

Distance of fire protection

How old is the heating/AC?

What is the heating system?

What is the cooling system?

Has the plumbing been Updated?

Yes No

Theft Alarm?

Yes No

Fire Alarm?

Yes No

What is the fire district

Are there dogs on the property?

Yes No

How many and what is the breed of each dog

Current coverage information

Current Insurance Company:

Policy expiration date

Any losses or claims in the past 5 years?

Yes No

What is the date, amaount paid, and description of each loss or claim?

Desired coverage information

Dwelling Amount (Coverage A)

Other Structures (Coverage B)

Business Property (Coverage C)

Loss of Use (Coverage D)

Premise Liability (Coverage E)

Policy Deductible Amount

Do you want building replacement cost coverage?

Yes No

Do you want contents replacement cost coverage?

Yes No

Other relevant information / Questions or Comments