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Home Quote Form

For the most accurate quote, please fill out the form below as completely as possible.


First Name
Last Name
Street
City
State
Zip Code
Daytime Phone() -
Evening Phone() -
Fax() -
E-mail Address
Date of birth
Is this home a new purchase?
Square footage of home
If a new purchase MLS number if available
If MLS number provided, skip to Pets question
If new purchase: price of home
Year built
House type (colonial, ranch etc.)
Number of Baths
Basement: finished or unfinished
Garage: attached/detached/under
Garage: number of bays
Fireplace?
Central air?
Siding type (clapboard, vinyl etc.)
Roof type (asphalt shingles, slate, tin)
Heating (oil, gas, electric)
Porch (enclosed, open)
Porch size: length/width
Deck size: length/width
Pets? type/breed
Smoker or Non-smoker
Comments

As part of the quote process, the insurance companies we represent may obtain reports on your claims history, driving record and financial responsibility.  These reports vary depending on the insurance regulations in the state you reside and the types of insurance you are seeking.


2204 Woodbury Ave., Newington, NH 03801 (603)430-1145
 91 Plaistow Rd., Plaistow, NH 03865 (603)-382-0155
Amesbury (978)388-5688; Haverhill (978)373-0077