Homeowners Quote

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Homeowners Insurance Quote

Name:

Home Phone

Your Email:

Cell Phone

Date Homeowners coverage needed:

Name on Deed

Applicant 1 (Deed):

Applicant 2 (Deed):

Location being Insured

Address (Insured Property):

State (Insured Property):

Social Security Number Applicant 1 (Insured Property):

City (Insured Property):

Zip Code (Insured Property):

Social Security Number Applicant 2 (Insured Property):

Mailing Address if different

Address (For Mailing):

State (For Mailing):

City (For Mailing):

Zip (For Mailing):

Years at Address (Insured):

Prior address of less than 3 years

Prior Address if less than 3 years:

Prior State if less than 3 years:

Prior City if less than 3 years:

Prior Zipcode if less than 3 yrs:

DOB for applicants (Important)

Applicant 1 DOB:

Applicant 2 DOB:

About Your Home

Date home was purchased:

Is the home currently under renovation? *

Yes

No

Year home was built:

Do you rent this property out? *

Yes

No

# of Miles from Fire Station:

Stories:

How many bedrooms:

Garage? *

Yes

No

Is this a secondary home? *

Yes

No

Within 1000 feet of fire hydrant? *

Yes

No

Type of Home (ie Colonial):

Square footage of Dwelling:

How many bathrooms:

Attached garage?

Yes

No

How many cars?

Basement? *

Yes

No

Full Basement?

Yes

No

% of Basement finished?

Large deck or screened porch? *

Yes

No

Size of deck or porch

Heating type?

Is there a wood, coal or pellet stove? *

Wood

Coal

Pellet

N/A

Type and age of roof:

Are rooms average or custom grade?

Is there an oil tank? *

Yes

No

Age of oil tank:

When was last update on wiring:

Do you have circuit breakers? *

Yes

No

When was last update on heating system?

When was last update on plumbing?

Sump Pumps

Do you have a sump pump? *

Yes

No

Do you have a battery back up system? *

Yes

No

How many sump pumps?

Are you interested in sump pump overflow coverage? *

Yes

No

Siding

What kind of siding?

Percentage siding on home?

Pool

Do you own a pool? *

Yes

No

Do you have a slide? *

Yes

No

Is pool fenced in? *

Yes

No

Do you have a diving board? *

Yes

No

Trampoline or Tree House

Do you have a Trampoline or Tree House? *

Yes

No

Pets

Do you have pets? *

Yes

No

Type/Breed:

Bite history? *

Yes

No

Business

Do you conduct business on the premises? *

Yes

No

Type of Business?

Occupation of all applicants

Applicant 1 Occupation:

Applicant 2 Occupation:

Insurance Carrier

Current Carrier

Policy #:

Current Premium:

Current dwelling amt on policy:

Current liability coverages:

Is policy in force? *

Yes

No

If so, how long?

Has your policy lapsed? *

Yes

No

Reason for lapse:

Any scheduled items (ie jewelry):

ANY homeowners claims in the past 5 years? If so, please provide dates, details and amounts paid out.

Purchase price (if new):

Mortgage Clause:

Mortgage Amount

Is your homeowners escrowed? *

Yes

No

What other type(s) of insurance are you looking for today?

Personal Property:

Renters

Condo

Flood

Umbrella

Vehicle:

Automobile

Motorcycle

RV or Motorhome

Classic Car

Business:

Business Owner's Policy

General Liability

Business Auto

Commercial Property

Workers' Comp

Commercial Umbrella

Bonds

Comment or Message:

Coverage will not be bound or changed until confirmed by a licensed agent.

Thanks for submitting your quote request! We will be in contact with you soon.

Please make sure all required fields are filled out before submitting.

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Franchino Agency

856 US Highway 206, Suite B11
Hillsborough, NJ 08844
Phone: (908) 359-2044
Fax: (866) 517-1868
Email: info@franchinoagencyinc.com

Mailing address:
Franchino Agency
P.O. Box 6403
Hillsborough, NJ 08844

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