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Homeowners Insurance Quote :

*Note that we may need information that you may not have memorized, therefore it is always a good idea to have your existing policy available to ensure we can assist in providing a more accurate quote.

Insured Name:
Contact Number:
Fax Number:
Email:
Mailing Address:
Location Address:


Is this a new purchase? If yes, please go to section 2. Otherwise, please complete both sections.
Section 1: 
Current Insurance Company:
Policy Expiration Date:
Policy Expiration Reason:
Current Policy Limits:
Property purchase date:
Section 2: 
New Purchase/Closing Date:
Will there be a mortgage: Yes:   No:
Will mortgage be escrowed: Yes:   No:
Do you have the mortgage
company clause & number:		 Yes:   No:
If so, please provide:
Company Name
Contact Name
Contact Number
Is this a primary or secondary residence: Primary:    
Secondary:
Is this a rental property: Yes:
No:
Living Square Footage:
Is there a garage: Yes:
No:
If so how many cars:
Number of Bedrooms:
Number of Bathrooms:
Do you have any additional property: Yes:
No:
What year was house built:
What year was electric updated:
What year was roof updated:
What year was plumbing updated:
What year was air conditioning updated:
What type of roof is on the property:
What shape of roof is on the property:
How many Glass/French doors on the property:
What is the construction type:
What is the property type:
How many stories?:
Do you have a pool: Yes:   No:
Pool Type: In Ground:      
Above Ground:
Is there a Pool Screen Enclosure: Yes:   No:
What year was enclosure installed:
Do you have a current appraisal: Yes:   No:
Does the property have a fireplace: Yes:   No:
Does the property have skylights: Yes:   No:
What is the current market value:
Claims History of past 5 years:
(Dates, Amount Paid, Cause of Loss)
Community Name:
Gated Community : Yes:   No:
*Do you own any recreational vehicles - atv's, boats, rv's: Yes:   No:
*Do you own collectibles,
fine arts or jewelry:		 Yes:   No:
*Note: If so, a seperate policy can be quoted to provide for this coverage.
Questions or Comments:
 
 

 

 Furey Insurance
Furey insurance is ready to serve both your personal and/or commercial needs.

Give us a call:
(561) 338-3312
www.Fureyinsurance.com

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Claims
If you have a claim to report, contact us during normal business hours. You may also submit your claim details online at the link below.

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