Hickey-Finn & Co. Inc.

Homeowners Insurance Quote Form

The information collected in this form will be used
only to provide you with a speedy insurance quote,
and will not be shared with any other parties.

Personal Information * Name:     Address:     City:     State: Zipcode:  * Phone: Fax:  * Best Times to Call:   * E-mail:             * Required Fields Property Information Location: Dwelling Insurance Amount: Liability Amount: Deductible Amount: Renewal Effective Date: Do you wish to have a Personal Umbrella Policy?   Yes No If so, how much liability coverage do you want? $1 Million $2 Million $5 Million In what year was your home built? Type of Construction: brick   frame     log cabin   other: Distance to Fire Department:   Within 5 Miles   More Than 5 Miles Distance to a Fire Hydrant:   Within 1,000 ft.   More than 1,000 ft. Update Information: Electric Updated Year Completed Heating Updated Year Completed Plumbing Updated Year Completed Roof Updated Year Completed     Circuit Breakers? Yes   No Check Appropriate Boxes: Kitchen Dining Room Living Room Den/Study Family Room Dinette Bedrooms   How Many?         Full Baths   How Many?         Half Baths   How Many?         Porch Enclosed? or Open? Attic Finished Unfinished Basement Finished Unfinished Garage Attached Detached   Number of Cars:   Central Air Aluminum Siding Fireplace How Many? Woodstove Professionally Installed? Yes No Comments:     Thank You!