HOME OWNERS QUOTE

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Home Owners Insurance Quote Request Form

Fill out the form below to obtain your Home Owners insurance quote. The quotes provided here are for Connecticut only. To obtain an accurate quote, please be as complete as possible. the Red fields are required and must be filled in.

Client Information

Name:

Business Name:

Address1:

Address2:

City/State/Zip: / /

Phone:

Fax:

Email:

Property Information
Property Address	Address1
	Address2
	City/State/Zip / /
Construction Type:
Year Built:	"yyyy"
Square Footage:	sq. ft.
# Rooms:
# Apartments:
Market Value:	$
Replacement Cost:	$
Structure Type:
# Families
# Household Residents:
Is any resident a smoker?:
Purchase Date:	"mm/dd/yyyy"
Purchase Price:	$
Distance to Hydrant:	feet.
Distance to Fire Station:	miles
Wired Alarm Systems (connections to fire/police authorities):	Fire Alarm?: yes/no
	Burglar Alarm?: yes/no
Fuel:	Gas
	Oil If "Oil" is checked, "Storage Tank Location" required. Storage Tank Location (ex. "basement"):
	Electric
	Wood
	Coal
	Solar
Please enter Year of Renovation, if applicable, for the items at right.	Electrical: yyyy
	Plumbing: yyyy
	Heating: yyyy
	Roof: yyyy
	Exterior Painted: yyyy
Occupied By:
Please check those which apply:	Deadbolt
	Smoke Detector
	Fire Extinguisher
	Property Visible to Neighbors
Swimming Pool?:	No
	Yes	Approved Fence
		Diving Board
		Above Ground
		In-Ground
Roof Type:	ex. "shingle"

General Information
Please check those which apply.
At Home Business:		Description:
Hazard present for flooding, brush fire, forest fire, landslide:		Description:
Animals/Pets:		Description/Breeds:
Property located within 2 miles of tidal water:		Description:
Property located on more than 5 acres:		Description:
Trampoline on Premises:

Rooms, Attics and Garages
Please enter the quantity of each type of unit in your home.
Kitchen
Dining Room
Dinette or Partitioned Breakfast Nook
Living Room
Den/Study/Office
Family/Recreation Room
Bedroom(s)
Bathroom(s)
Half Bath
Dressing Room/Walk-in Closet
Large Utility/Laundry/Sewing Rooms (Over 150 sq. ft.)
Small Utility/Laundry Sewing Rooms (Under 150 sq. ft.)
Foyer/Entrance Hall
Mudroom (With separate entrance)
Enclosed Porch/Breezeway
Large Open Porch/Breezeway
Finished Basement (Omit if counted as family/rec room)
Partially Finished Basement
Unfinished Basement
Large Finished Attic (Over 150 sq. ft.)
Partially Finished Attic
Unfinished Attic
Small Finished Attic (Less than 150 sq. ft.)
Built-in 2-Car Garage/Carport
Built-in 1-Car Garage/Carport
Attached 2-Car Garage
Attached 1-Car Garage
Large Wall Fireplace
Standard Fireplace
Brick/Stone Exterior Walls
Aluminum/Vinyl Siding
Brick/Stone Veneer (Front Wall)
Clay Tile or Slate Roof
Central A/C
Any Other Unit Not Listed Here		Description:

Select the Method you would like this Quote Forwarded to you If the address or number you want the quote sent to is different from what you specified above then specify the new one after the selected method. We will send you a prompt reply. Thank you for considering the Prindle Insurance Agency.
Email
Fax
Letter


		/ /
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Thank you for considering the Prindle Insurance Agency! Be sure you have completed the required fields and have provided us a method of forwarding your Home Owners Insurance Quote to you. If you have any other information you would like for us to consider or you have general questions or comments, please enter them in the box below, then click the submit button. We will respond to you promptly.

Comments / Questions


Thank you for considering the Prindle Insurance Agency!

The Prindle Insurance Agency is a member in good standing with:

The National Association of Independent Insurance Agents

The National Association of Professional Insurance Agents.

Prindle Insurance Agency
22 West Main Street
Sharon CT 06069
Phone: 1 860 364 5000
Toll Free Number: 1 877 422 4555
Fax: 1 860 364 5072

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