J.M. Strange & Company -- Insurance * Bonds

Disclaimer

Please note completion of any request(s) for information does not constitute the purchase of insurance. No coverage may be added, changed or bound as a result of submitting a request for information or quotation of insurance. All coverage must be confirmed by the agency in writing subject to an acceptable signed application meeting the underwriting guidelines of the Insurance Company.  I have read and agree with the above disclaimer.   (Box must be checked before request can be sent)

General Information
Name:
Address:
City:	State:   Zip:
Day Phone:	Night Phone:
Best Time To Call:	AM   PM
Email Address:
Best Contact Time:
Property Address (if different):
City:	State:   Zip:

Current Flood Insurance Information
Company Name (not agency):
Policy Expiration Date:	Policy Type: Primary Secondary

Home Information
How Long At Present Address:	Year Home Was Built:
Lender Name:
Lender Address:
Sq. Footage (excluding garage and basement):	sq. ft.         # of Claims In Last 3 Years:

Structure Information
Type	Construction	Roof	Foundation	Garage
1 Story 1 1/2 Story 2 Story Split Level Bi-Level Other	Frame Stucco Veneer Masonry Other	Asphalt Shingle Wood Shingle Tile or Slate Other	Basement Crawl Space Slab Other	1 Car 2 Car 3 Car 4 Car None
		Age of roof: yrs.		Attached Detached Basement Built-in Car Port None

Coverage Desired
Deductible's:	Dwelling: $500 $750 $1,000 $2,000 $5,000	Contents: $500 $750 $1,000 $2,000 $5,000
Dwelling Coverage:	Select preset limit below: $25,000 $30,000 $35,000 $45,000 $50,000 $60,000 $65,000 $75,000 $85,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000	Or enter your own limit (can't exceed $250,000): $
Contents Coverage  (Personal Property):	Select preset limit below: $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $45,000 $50,000 $60,000 $65,000 $75,000 $85,000	Or enter your own limit (can't exceed $85,000): $
Your Personal Property is Located:	Basement Only   Basement and Above   Lowest Floor only above ground level (basement not incl)   Lowest floor above ground level and above

 

Miscellaneous Information
Do you qualify as a small business risk?:	Yes     No
Is building your principle residence?:	Yes     No
Is the building in the course of construction?:	Yes     No
Is insured property owned by state government?:	Yes     No
Is your building elevated?:	Yes     No
Is your building in a special flood hazard area? (if not certain leave blank):	Yes     No
FEMA (flood rate zone) (if not certain leave blank):	A AE AH AO AR A99 D V VE X Other Not Known

 

Additional Comments

Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

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