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Contact us

Post Office:
464 Bay Ridge Avenue
Brooklyn, NY 11220-5996

For more information

Telephone:
(718) 836-1100 Local NYC
(800) 253-1490 Toll Free

Fax:
(718) 833-1582

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Homeowner/Fire Dwelling Quote
General Information
*Name:
*Address:
 
*Phone:
Work Phone:
 
Social Security #:
Date of Birth: MM/DD/YYYY
Type of policy requested:
Requested Date: MM/DD/YYYY

Rating Information
# of Families: 1 2 3 4
# of Stories: 1 2 3 4
Construction: Fr Mas Sup Other
  Detached Attached Semi To
Dwelling Amount: $ Deductible: $
Personal Liability: $100,000 $300,000 $500,000

Underwriting Information
Basement: Finished Unfinished      Separate Entrance? Yes No
Garage: 1-car 2-car Attached Detached Built-in
# of Air Conditioners thru walls: Central Air? Yes No
# of Full Baths: Dead Bolt Locks? Yes No
# of ½ Baths: Smoke Detectors? Yes No
# of Fireplaces: Fire Extinguishers? Yes No
Year Built: Central Station? Yes No
Square ft.:
 
Renovations Electrical: Amps? Volts? CB     Fuses
Plumbing:
Heating: Gas Oil Loc. Of Oil Tank? 
Roof: Arch/Shingle Flat Tar/Gravel  Rubber
 
Previous Carrier:
Losses:
 
* Required fields