Request a Quote: Homeowner's Insurance

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Request a Quote: Homeowner's Insurance

To request a homeowners insurance quote, please fill out the form below.

At this time we can only offer homeowners insurance to residents of New York State.

Please not that fields denoted with a * below are required.

General Information

Last Name: *

First Name: *

Telephone (Home): *

Telephone (Work):

Address: *

City: *

State: *

Zip: *

Email: *

Do you rent or own your Home?: *

# of years at current address: *

Present Auto Insurance Company:

Expiration Date, Month (Auto Ins):

Expiration Date, Year (Auto Ins):

12 Month Premium (Auto Ins):

Present Homeowners Insurance Company:

Expiration Date, Month (Home Ins):

Expiration Date, Year (Home Ins):

12 Month Premium (Home Ins):

Homeowners Insurance Information

Year Built: *

How Many Stories?: *

Total Square Footage (Excluding Basement): *

Sq. Ft.

Basement Square Footage:

Sq. Ft.

Basement: *

Finished

Unfinished

Construction:

Masonry

Wood Frame

Construction (Other):

Garage Type: *

Amount Of Insurance On Dwelling $: *

Deductable $: *

Personal Liability $: *

Contents Limit $: *

Alarm System (Check All That Apply): *

Audible Burglar

Audible Fire

Central Station Burglar and/or Fire

Dead Bolt Locks

Smoke Alarm

Do You Own Any Pets?:

Do You Have a Personal Umbrella Policy?: *

If Yes, What Amount?:

# of Houses: *

# of Automobiles: *

# of Boats: *

# of Young Drivers: *

Jewelry?: *

No

Yes

If so, what limit? $: *

Enter $ Amount or 0 For None

Silver / Silverware $: *

Enter $ Amount or 0 For None

Guns $: *

Enter $ Amount or 0 For None

Fine Arts $: *

Enter $ Amount or 0 For None

Any Business Conducted In The Home?: *

No

Yes

If yes, please give details:

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Edmund D. Stevens Insurance is a dedicated insurance agency committed not only to professional results
in insurance coverage but also to making the process personal - customized to your unique needs.

When you choose The Stevens Agency, you put the strength of our teamwork and experience on your side.

© 2009 Edmund D. Stevens Insurance| Contact Us | 716.856.3387 | 716.856.9890 FAX

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