All Risk Insurance Agency

House - Contact All Risk Insurance Agency in Southington CT, for all your insurance needs including bussines and personal property, auto, umbrella,tenats and condo policies.

Phone:

(860) 757-3990

Fax:

(860) 757-3991

E-mail:
petulia@all-riskins.com

Homeowner Quote Form

Personal Information

Name:

Address:

Home Phone:

Mobile/Work Phone:

Current Insurance Co.:	Ex. Date:	Premium:
Claim History/ Losses in the past 5 years:(loss date, amount paid, description)

Home Features:

Year Built:

Construction Type:

# of Families:

# of Stories:

Total Sq Footage:

Siding:
Yes No

Type:

Style of House:

Garage:
Yes No

# of cars:

Attched Detached Built in/Under

Security System:
Yes No

Fire Theft

Central Station Direct Notification

Finished Basement
Yes No

% Finished:

# of fire places:

# of chimneys:

Woodstove:
Yes No

Inspected:
Yes No

Distance/Fire Dept.

Distance/Fire Hydrant:

Pets/Dog Breed:

Patio/porch/deck/breezway sq ft:

Main Source of Heat:

Updates:

Roof (yr):

Furnace:

Plumbing:

Electrical:

# of Baths:

Central Air:
Yes No

Pool:
Yes No

Pool Type:
In Ground Above Ground

Fenced:
Yes No

Hardwood floors:
Yes No

Granite/ Ceramic Tile:
Yes No

Other Features/ Custom Work:

Current/ Requested Coverage

A. Dwelling

B. Other Structures:

C. Personal Property:

D. Loss of Use:

E. Personal Liability:	F. Medical:
Deductible:	Scheduled Items :

Other: