Home Owners Insurance

Insurance companies began by insuring homes against fire. Since that time, coverage has expanded to include personal liability, personal property, and other structures on your property like a shed or detached garage. Based on your situation, you may want to add coverage for a boat or other equipment. You may have jewelry, fine art, furs or antiques that require special coverage.

If you are a homeowner, renter or condominium owner, let us design the right coverage for you.

For a quote, please complete the form below or call our office for a personal consultation.

Name
(First, Middle, Last):
Address:
City: State: Zip:
Phone: Work #: Ext: Home #:
Email: Fax #:
Best Time to Reach: Morning Afternoon Evening
Best Way to Reach: Phone Fax Email

Property address if different from above:
Address:
City: State: Zip:

Current Coverage

If you have a policy in force, please fill in the following:

Dwelling: $ Other Structure: $
Personal Property: $ Liability: $
Deductible: $250 $500 $1000 $2500

New Home Owners

Dwelling Value: $
Deductible: $250 $500 $1000 $2500

Underwriting Information

Age of Home: years Number of Families:
Type of Structure: Number of Floors:
Total Square Footage of Dwelling (if known): sq.ft.
Porches: Open Enclosed Decks: Yes No

Please list year for any of the following updates:
Plumbing Electrical Heating Roof

Basement is: Slab Unfinished Finished % Finished
Attached Garage: Detached Garage:
Carport: Basement Garage:
Number of Fireplaces:
Unique Features:
Fire Protection:
w/in 1000 ft. of hydrant Yes No w/in 5 miles of fire dept. Yes No

Do You Have?

Dog/Horse: Yes Breed: No
Detached Structures: Yes List: No
Trampoline: Yes No
Central Air: Yes No
 Pool:
Premise alarm: Local Central station
Smoke Detectors: Yes No
Smokers: Yes No

Scheduled Items

Jewelry $ Computers $
Silverware $ Furs $
Fine Arts $ Other $
 Description of other:

In-Home Business

Yes No

 If Yes, type of Business:

Recreational Vehicles

  Boat ATV Snowmobile Aircraft None

Other Residences Owned/Rented: Yes No
Locations:

  Any Homeowners Losses in the Last 5 Years: Yes No
  If Yes, List Year, Describe Loss and Give Amount Paid by Insurance Company:
        1.
        2.
        3.

Additional Comments

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    Aquadro & Associates Insurance Agency Inc ~ 355 Bridge Street ~ P.O. Box 357 ~ Northampton, MA 01061 ~ 413-586-7373 ~ 1-800-878-7374