Homeowners Quote Request

Homeowners Quote Request Form
Syracuse Insurance Agency

To Request a Comparative Homeowners Insurance Quote from Syracuse Insurance Agency and Affordable McLaughlin & Kehoe Agency, please fill out the following information as completely as possible so that we have have enough initial information to begin the quoting process.  We will usually need to contact you for additional information as needed during the course of the quoting process.
If you are currently have an existing homeowners or renters policy, please email or fax us a copy of the Declarations Pages that list your current coverage limits and options so that we may make a direct comparison quote as close as possible to your current coverage and limits.
Fax: 315-437-5272     
email current policy pages to:  quotes @ SyracuseInsurance.com           
Or call us at 315-413-5005 to follow up or more information.

PERSONAL INFORMATION
First Name: *
Last Name: *
Address Street 1: *
Address Street 2: *
City: *
Zip Code: * (5 digits)
State:
Daytime Phone: *
Evening Phone:
Date of Birth *
 Social Security Number:  
   
 Current Home Info:  
   
Current Insurance Co. Name:
Is Home Currently Insured:
Current Insurance Policy End Date::  
Current Dwelling Limit Insured $:  
Current Liability Limit $:  
 Current Deductible Limit $:
Any Claims in Past 3 Years::
Describe Claim, Date, Amount:  
 # of Mortgages on Home:
 Names of  All Deeded Owners:  
 Mortgagee Name & Address:  
 Any Animals in Home?
 - type and breed?:
 
   
 Own a Trampoline? :
 Pool:
   
 Dwelling Information  
   
 Year Built: *  
 Style of Home:
 # of Stories:
 Roof Type: *
 Square Footage of Home: *  
 Construction Type:
 Date Purchased:  
 Number of Families: *
 Updates- Roof, Furnace, Plumbing,Electric ? - Year?:  
Electric Service Panel Type::
 # Bedrooms:  
 # Full Baths:  
 # Half Baths:  
   
   
Comments:
 Security Code: *   

Important Notice
Any submissions  made via this website does not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party. 
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