James W. Hennigan Insurance Agency, Inc.

           1208A VFW Parkway   West Roxbury MA 02132
                Tel    617-327-9200     Fax   617-327-8414

Homeowners Quote

Required Fields *

Policy Holder

Name*

Email*

Phone Number*

Property Location

Address*

City*

State*

Zip/Postal Code*

Current Insurance Information

Company Name

Current Annual Premium

Expiration Date

Deductible Desired

Amount of Liability

Earthquake Coverage Desired?

YesNo

Have you filed for bankruptcy within the past 7 years?

YesNo

Dwelling Information

Estimated Replacement Cost

Square Footage

Year Constructed

How old is your roof?

Type of Heating System

Last Plumbing Update (mo/year)

Last Electrical Update (mo/year)

List Quantity and Type of Pets

How Many Floors?

1 Story

1.5 Story

2 Story

Bi-Level

Tri-Level

Other

Type of Construction

Wood

Stucco

Masonry

Brick Veneer

Aluminum Siding

Other

Other Features
(check all that apply)

Dead Bolts

Smoke Detectors

Fire Extinguisher

Central Station Fire Alarm

Central Station Burglar Alarm

Home Located Within 5 Miles of Fire Station

Home Located within 1,000 feet of a Fire Hydrant

Swimming Pool

Trampoline

Home Located within City Limits

Claims
List any claims in the past 3 years:

Date of Claim

Amount Paid

Claim Type

Description

Appraised Property
Estimated Value of your personal property:

Jewelry & Watches

Furs

Silver

Disclaimer Notice: - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and down payment.