Personal and Commercial insurance to our friends and neighbors
for over 40 years

McGee and Noto Agency - 1819 E. Ridge Road - Rochester, NY 14622 - 585-342-4920


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Home Owners Insurance Quote

YOUR PERSONAL DATA
   
Name:  
Property Address:  
City:  
Your "County" Is?  
State: (Must Be NY)  
Zip Code:  
E-Mail (REQUIRED):  

E-Mail again for accuracy:  
Phone:  
Fax (optional):  
DWELLING INFORMATION
Year Home Built:  
Home Square Footage:  
Is This Builder's Risk?
(New Home Construction)
  Yes No
Month/Year home to be complete:  
Number of Units:   Single Family Duplex
Type of Foundation:   Slab
Crawlspace Over Slab
Pier and Post
Other (List in Remarks)
Type of Construction:   Frame
Brick/Veneer
Stone
Other (List in Remarks)
Type of Roof:   Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal Other
Number of Stories   One 1.5
Two Three
Do You Have a Trampoline?   Yes No
Do you own animals or pets?
If Yes, list type/for dogs list breed:
  Yes No
Are You Near Brush Area?   Yes No

# of feet to nearest fire hydrant:

 

# of miles to nearest fire station:

Currently Insured?   Yes No
Name of Carrier & how long insured?  
Prior Claims?   Yes No
Describe claims in detail:  
Rate Your Credit History and Past Insurance Payment History:
(Some companies products are based on your credit and payment history.)
  Excellent Fair
Poor Horrible
Primary Policyholder's Birthdate:
(Some companies products offer discounts for certain age groups.)
 
Plumbing type:   Copper Galvanized
Mixed (Copper/Galvanized)
Heating Type:   Gas (Propane or Natural)
Electric
Oil (if oil, list tank location in remarks)
Circuit Breakers or fuses?   Breakers Fuses

# Bedrooms:

 

# Bathrooms:

# Fireplaces:   # Chimneys:

COVERAGES:
Dwelling Cov. $   Contents $
Liability Cov. $   Deductible $
($250, $500, $1,000, etc.)
Comments/Remarks:
(describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here):
 
Send my quotation via:   E-Mail Fax Regular Mail
Call Me By Phone


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