Northeast Insurance Agency Inc. - Homeowners Insurance Services in Auburn, MA
 

Get a Quote for Rental Property Insurance
Step 1. Personal Information
Step 2. Property Information
Step 3. Home Systems
Step 4. Home Details
 

Name and Contact Information

First Name
Middle Initial
Last Name
Work Phone  Fax 
Home Phone
E-mail

Your Address
Address
Address 2
City
State      Zip  

Property Address

Address
Address 2
City
State      Zip  
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Get a Quote for Rental Property Insurance
Step 1. Personal Information
Step 2. Property Information
Step 3. Home Systems
Step 4. Home Details
 
 

Purchase Information

Purchase Date
Purchase Price
Mortgage
Square Footage

Ground Floor Square Feet  Total Living Area
Year Built
# of Families
# of Stories
   
   

General Information
Age of Homeowners  Owner 1  Owner 2
Will home be owner occupied? Yes   No

If not, explain
Will occupants of the home be non-smokers? Yes   No
Any Pets? Yes No
If yes, what type?
If dog, what breed?
Is there a trampoline on premises? Yes No
Any business conducted on premises? Yes No
If yes, explain
Is there a daycare on the premises? Yes No
If "yes", how many children are you licensed for?
Any domestic employees? (e.g. nanny, maid) Yes No
Are there any other structures on the premises? (e.g. barn, garage) Yes No
Is house vacant or under construction? Yes No
Will dwelling be sold within the next year? Yes No
Any commercial exposure within 1000 Ft? Yes No
If yes, explain
Have you had insurance canceled or declined in the past 3 years? Yes No
If yes, explain
Any claims in the past 5 years? Yes No
Explain,including dates and amounts paid
Are you interested in earthquake insurance? Yes No
Are you interested in flood insurance? Yes No
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Get a Quote for Rental Property Insurance
Step 1. Personal Information
Step 2. Property Information
Step 3. Home Systems
Step 4. Home Details
 
 
 

Home and Home Systems Information

Electrical System
(check all that apply)		 Circuit Breakers  
Fuses
<100 amp service
>=100 amp service
>=200 amp service
Other 
Year Electrical System last updated
Plumbing System
(check all that apply)		 Copper Pipes
PVC Pipes
Lead Pipes
Other 
Year Plumbing last updated
(including water heater)
Heating System (check all that apply) Oil - Forced Hot Water
Oil - Forced Hot Air
Gas - Forced Hot Air
Gas - Forced Hot Water
Other 
Is there an oil or propane tank underground? Yes No
Roof (check all that apply) Asphalt Shingles (most common)
Clay Tile
Slate
Other 
Construction Type Wood Frame
Joisted Masonry (Brick)
Masonry Non-combustible
Other 
Fire or Burglar alarm type Smoke Detectors
Local Burglar and/or Fire
Central Station Fire and Burglar
Central Station Fire only
Central Station Burglar only
Other 
  
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Get a Quote for Rental Property Insurance
Step 1. Personal Information
Step 2. Property Information
Step 3. Home Systems
Step 4. Home Details
 
 
 
 

Home Details   Please enter the number of the following units in your home
Bedroom(s)
Full Bathroom(s)
Half Bathroom(s)
Attached Garage    # of bays 
Open Porch/Deck    sq. ft. 
Enclosed Porch
Pool In Ground
Above Ground
Fencing Around Entire Pool
Diving Board or Slide
Wood or Pellet Stove
Fireplace     # of chimneys 
Finished Basement Yes No     sq. ft. 
Sump Pump in Basement or 1st Fl. Yes No
Central Air Conditioning Yes No
Aluminum or Vinyl Siding Yes No
Brick or Stone Veneer on Outside of Home Yes No
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