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Massachusetts Homeowners
Insurance Quote

Please fill out the information below and click "submit". If you make a mistake click "reset".

Homeowner Information
Name
Property Street
Property City
Property State
Property Zip Code
Telephone
E-mail (required)

Homeowner Coverage's *Indicates our recommended limits
** Part A: Dwelling Limit	Part B: Other Structures	Part C: Personal Property	Part D: Loss of Use
	Usually 20-30% of Part A	Usually 50-70% of Part A	Usually 20% of Part A
** Replacement cost of your home not including the land. This is not the market value.
Part E: Personal Liability	Part F: Medical Payments	Deductible	Earthquake Coverage
$100,000 $200,000 $300,000* $400,000 $500,000	$1,000 $2,000 $3,000* $4,000 $5,000	$250* 500 $1,000	Yes No

Property Information This will help us to determine which company to quote.
What year was your home built
If home is older than 20 years please advise the date the following items were updated and if it was a full or partial update.	Plumbing None Partial Full Year Heating... None Partial Full Year Electrical. None Partial Full Year Roofing.... None Partial Full Year
Is this your primary residence?	Yes No
Number of Families	1 2 3 4
# of units rented to others	0 1 2 3 4
Construction Type	Frame Masonry Aluminum Siding Masonry Veneer
Does your home have smoke detectors?	Yes No
Does your home have a central burglar alarm?	Yes No
Does your home have a central fire alarm?	Yes No
Do you have a Dog? If YES, what breed?	Yes No
Does your home have a wood burning stove? If YES, has it been certified by your local fire department?	Yes No Yes No
Do you have a pool? If YES, does it have a diving board?	Yes No Yes No
Do you have a trampoline?	Yes No
Does your home have an underground fuel tank?	Yes No
Do either you or your spouse smoke?	Yes No
Are either you or your spouse age 55 or older?	Yes No
Do you currently have a homeowner's policy? Have you had any claims within the past 3 years? If Yes, please describe with amount actually paid.	Yes No Yes No
Do you have an active auto policy with Commerce Insurance?	Yes No

Current Policy Information
Company Name (not agency):
Policy Expiration Date:
Premium Amount:

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Comments

PLEASE NOTE: These insurance quote's are estimates and although depict a fairly accurate figure, do not represent the true cost. Because of the many attributes that determine price and coverage an exact figure can only be given after completing a full application.

• Massachusetts Homeowners Insurance