Colonial Insurance Agency, Inc.
310 North Main St., Unit #6
Mansfield, MA 02048
(Tel) 800-571-7773 (Fax) 508-339-8991 |
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Home Insurance Quote |
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Please fill in all the boxes on this form,
print and fax to: (508)
339-8991 |
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Property
Information |
| Year Built |
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| Number of Families |
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| Construction Type |
Circle One:
Wood Brick |
| Type of Dwelling |
Circle One:
Home Condo Renters Rental
Property |
| Smoke Detectors |
YES NO |
| Deadbolt Locks |
YES NO |
| Alarms |
YES NO |
| Replacement Cost for Dwelling
Desired? |
YES NO |
| Replacement Cost for Contents
Desired? |
YES NO |
| Dwelling Limits |
Market Value or Write Current Amt. here
_____________ |
| Liability Limits |
Circle One:
$300,000.00 $500,000.00 |
| Deductible |
Circle One:
$250.00 $500.00 $1,000.00 |
| Owner Occupied |
YES NO |
| Within 2 miles of the Coast |
YES NO |
| Name:
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| E-mail:
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| Property
Address: |
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| Mailing
Address: |
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| City: |
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| State: |
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| Zip
: |
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| Phone:
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| Fax:
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Write comments or questions
below: | |