71 County St., Attleboro Massachusetts

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Homeowners Insurance Quote Form
Providing homeowners insurance quotes in Attleboro, Massachusetts and surrounding area.

Privacy Policy:  All information submitted to us via this web-site or via e-mail will be used exclusively by the Holman Insurance Agency, Inc. in order to provide quotes or service.  We will NOT provide your information, including e-mail addresses, to any other company or service for any other reason, and we will not use any information you provide in our other marketing programs.
 
Name:
Address of Property to be Insured:
City:

State: 

Zip: 

Phone:  Fax   
E-Mail:

Home Description        Questions on homeowners insurance?  Visit our Homeowners FAQ Page.

Construction Brick Frame
 
Year Built
# of Families
Style
Living Area (Square Feet)
Owner Occupied?   Yes No

Please advise the year the following items have been updated if home is over 30 years old:
 
Plumbing
Heating
Electrical
Roof
Do you have smoke detectors? Yes No
Do you have fire extinguishers? Yes No
Central Station Burglar Alarm? Yes No
Central Station Fire Alarm? Yes No
If you own autos, would you be interested in combining the autos with the 
homeowners policy for additional discounts?		 Yes No
Does the home have Circuit Breakers w/ at least 100amp service? Yes No
Is there a trampoline on premises? Yes No
Do you have a Dog? If Yes, please list breed Yes No
(Most companies have restrictions on the breeds of dogs they will write.  Common breed restrictions
 include: German Shepherds, Rottweilers, Pit Bulls, Dobermans, Airedales and mixes with these breeds)
How would you rate your own credit?   

Coverage Limits

Dwelling
Contents
Liability
Deductible
 
Do you require Flood Insurance?
Flood Insurance Losses are not covered under a homeowners insurance policy, for more information on the National Flood Insurance Program, click HERE 
Do you require Earthquake Insurance?
Earthquake losses are not covered under the standard homeowners policy.

List any items which you desire to have scheduled for an agreed amount, 
e.g. Jewelry, Furs, Silverware:

General Information

Have you had any homeowner claims or losses within the last 5 years? If so, please explain
:
 
Do you have a swimming pool? Yes No
If so, is the pool completely fenced in? Yes No
Is this your first home? Yes No
Are you in the process of purchasing this home? Yes No
Do you currently have insurance on this home? Yes No
How many years have you had homeowners insurance?
Current policy expiration date?
Current Insurance Company

Any Additional Comments:

TERMS & CONDITIONS: Holman Insurance Agency, Inc. cannot bind, modify or cancel coverage via submissions to our website, or by messages sent through e-mail. Completion and submission of this form or e-mail does not constitute either a binder or an application for insurance. This site provides quotes and information only. An application signed by you and our agent is required for insurance to become effective.  By clicking SUBMIT,

 

Please submit only if you are seeking insurance in the Attleboro, Massachusetts or surrounding area.  If you're looking for an insurance quote from outside this area, you can find an Independent Agent in your area by clicking here


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