Hannigan Insurance Agency - Home Insurance

Home Insurance

Complete the following information and we will process your quote and contact you to review your coverages and premium.

Disclaimer: Ths is not a final quote, nor is it an offer of insurance. Any quote is based only upon the rating information you have provided and may be subject to additional rating variables. This is for informational purposes only. This is not a contract and insurance coverage is not being provided.

Your Address Information:

Full Name:
Date of Birth:
Marital Status:
Social Security Number:
Address 1:
Address 2:
City:
State:
Zip Code:	(5 or 9 digits)
Home Telephone:
Work Telephone:
Email Address:
Occupation:

Basic Coverage Information:

Construction:
Year Built:	(i.e. 1995)
Usage:
Policy Type:
Style of Home:
Personal Liability:
Deductible:
Dwelling Coverage (on current policy):	(of current policy)
Market Value of Home:	(i.e. $200,000)
Total Square Feet:	(i.e. 2,500)
Foundation Type:
Garage Type:

Scheduled Personal Property: (i.e. Jewelry Riders -- optional)

Please enter any scheduled items:

Protective Devices:

Burglar Alarm:
Fire Alarm:
Deadbolt:
Fire Extinguishers:

Underwriting:

	Year of repair or replacement:
Electrical:	(i.e. 1995)
Roof:	(i.e. 1995)
Plumbing:	(i.e. 1995)
Heating:	(i.e. 1995)
Do you own a dog (if yes, type of breed):	(i.e. Yes, Poodle)
Swimming Pool:
Type of Wiring:
Losses in past years:
Describe Losses:

Additional Information:

Who is your current insurance carrier:
When does your policy expire:
Your current 12 month premium cost:
How did you hear about us:
Name of referring company or individual:

Thank you for your interest.