Name                 Required

E-mail address    Required 

Address              Required

City                    Required

State                     Massachusetts Residents Only

Phone                  Fax 

Amount of Building Insurance      150,000 175,000 200,000 225,000 250,000 300,000 350,000 400,000 450,000 500,000

Amount of Liability Insurance      500,000 300,000 1,000,000

Year house was built                      2001 - new 2000 - 1991 1990 - 1971 1970 - 1951 1950 - 1931 before 1930

Type of house                                  2 story colonial Cape Split level 1 story Raised Ranch Other

Size of your house  square feet    or

number of rooms                            

Replacement cost contents         Yes No

Your house is a     1 family house 2 family house 3 family house 4 family house

Comments

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