JOSEPH E. SCHINDLER INSURANCE AGENCY

One Wall Street
Burlington, MA. 01803
Phone 781.272.7505

 

HOME OWNER INSURANCE QUOTE

PERSONAL INFORMATION
Your Name 
Property Address
City
State    Zip Code 
Daytime Phone
Evening Phone
Most convenient time to call AM    PM
E-Mail address
Have you filed for bankruptcy
within the last 7 years?
 
CURRENT INSURANCE INFORMATION
Insurance Carrier Name
(Not insurance agent)
Current Annual Premium
Expiration Date
Amount of Coverage
Year Built
Number of Stories
Ground floor Square Footage
Type of Construction
Deductible
Amount of Liability
Earthquake Coverage
SCHEDULED PERSONAL PROPERTY
Jewelry and Watches
Silver
Guns
Furs
Stamp & Coin Collection
Fine Arts and Breakable Items
   
Check all that apply  
Deadbolts Yes    No
Smoke Detectors Yes    No
Fire Extinguishers Yes    No
Central Station Fire Alarm Yes    No
Central Station Burglar Alarm Yes    No
Swimming Pool Yes    No
Trampoline Yes    No
Dog Yes    No
Type of Dog
Any Claims made within
the last 3 years?
Describe Below:  

All quotes are provisional, based on the information provided and subject to change upon obtaining additional information.  If you would prefer to talk to an agent please contact us.