New York insurance quotes from Mazzola Insurance.org
   Home FAST Auto Quote! FAST Home Quote! FAST Truck Quote! Map/Directions About Us   


Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
Your "County" is?
State: (Must be New York)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
Primary Insured's Occupation:
 
Primary Policyholder's Birthdate:
(REQUIRED - Some companies products
offer discounts for certain age groups.)
 
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Is this Builder's Risk?
(new home constr.)
NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
 
Type foundation: Basement
Slab
Crawlspace over slab
Other (list in remarks)
(If basement, what % is finished?)
% FINISHED
 
Type Construction: Frame
Brick/Veneer
Stone
Other (list in remarks)
 
Type Roof: Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Does Home Have a Garage? Yes No
Tell whether built in, detached/attached, and how many cars?
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Rate Your Credit History and Past Insurance Payment History:
(Some companies products are
based on your credit and payment history.)
Excellent Fair
Poor Horrible
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
 
Heating Type: Gas (Propane or natural)
Electric
Oil (if oil, list tank location in remarks)
 
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!


Select a Fast and Free New York Insurance Quote Request from Mazzola Insurance.org
Auto   |  Homeowners   |  Truck   |   Motorcycle   |  Boat   |  Snowmobile   |  Trailer  |  Umbrella  |  Contractor  |  Bonds  |  Floater
NY insurance quotation
Our Other Fine Services - We're Here to Help You!
Privacy Notice   |  More About Our Agency  |  Map/Directions  |  Website Design: Insurance Web Sales © 2010

from Mazzola Insurance.org The Online Services of Mazzola Insurance Agency
Mazzola Insurance.org - Fast New York Auto Insurance, Homeowners Insurance, Truck and Boat insurance and Business Insurance quotes for NY residents and businesses. Free online New York personal and business insurance quotes at very low rates. Keywords our customers use to find our services include: New York auto insurance, NY car insurance, New York homeowners insurance, NY boat and yacht insurance, New York contractors insurance, and contractor bonds, low cost New York personal and business insurance, save money on New York insurance, discounts on all NY insurance plans, fast online New York insurance quotes.

* We Provide the Lowest Legal Rates As Allowed In New York.