11/22/2008 02:42:06 AM



359 Washington Street - Brighton MA 02135 | Tel 617-787-4205 | Fax 617-787-4329
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Get a quote for Massachusetts Renter's Insurance
Request Quote for Renters Insurance.

Renter's Insurance Quote Request

No coverage is bound until you are contacted by someone from our staff

 CONTACT INFORMATION
 Name  
 Street Address  
 Street Address/Apt #  
 City, State, Zip  
 Phone Number   Home    Work 
RATING INFORMATION
 1. What year was this dwelling built?
 2. What type of dwelling?
 3. What type of construction?
 4. Do you have a fireplace?
      If yes, please describe what type
 5. Do you have a woodstove?
 6. What is the primary source of heat?
 7. What is the secondary source of heat?
 8. Do you have a security system?
      If yes, please describe what type
 9. Have you had any losses in the past 3 years?
      If yes, please describe
 10. Do you have renters insurance now?
 11. Do you own any pets?
    If yes, Please describe 
COVERAGE INFORMATION
 1. What is the total value of your personal property? $
 2. Do you want earthquake coverage?
 3. Do you have collections worth over $500?
    If yes, Please describe 
 4. Do you have any single piece(s) of jewelry valued over $500?     
    If yes, Please describe 
 5. Do you have work tools that need coverage?
    If yes, Please describe 
 6. Do you operate a business out of your residence?
    If yes, Please describe 

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Joe Eldridge
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