Parsons & Associates. Inc. -- Insurance & Risk Management

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Homeowners Insurance Proposal Form
For the fastest and most accurate homeowners insurance proposal, please provide as much information possible in the form below. This information will be kept confidential and will be used for proposal purposes ONLY!


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Privacy Statement: Any information provided by a consumer or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. Our goal is to respond to all submissions within two business days.

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We only accept inquiries for insurance written in New York State

General Information
Name:
Address:
City:   State:    ZIP:
County:   Email:
Phone Day: ( ) -            Night: ( ) -
Best time to call:   am  pm
Occupation:         How long at current job: years   months
Soc. Sec. #*:         Date of Birth:

*Please Note: In order to provide you the most accurate policy quote, some of the companies we represent may require a credit and/or claims history which require your Social Security Number. You do not have to provide social security numbers at this time, however we cannot guarantee that we can provide you the most accurate quotation until we secure your credit information. We will not share this infomation with any other entity other that prospective insurance companies that will assist us in preparing your quote. All information on this form will be strictly used for internal purposes only

 
Current Homeowners Insurance Company (not agency):
Company Name:
Policy Exp. Date: / /
Amount Insured For: $
Premium: $
Term: 6 Months   1 Year   Other  

Home Information
How long at present address: years months # of claims in last 3 years:
       
Sq. footage of home (excluding
garage and basement):
Year home was built:

Structure Information
Type: Construction: Roof: Foundation: Garage:
  Age of roof:   yrs.  

Features
Bathrooms: Basement: Deck/Porch/Patio: Fireplaces:
  # of Full:  
  # of Half:  

Sq. Ft:
Deck Sq. Ft:  
Porch Sq. Ft:  
  Screened Patio Sq. Ft:  
 # of Chimneys:  
 # of Hearths:  

Additional Features
Heating System: Central Air: Central Vac: Security Alarm: Fire Alarm: Smoke Detector:
yes
no 
yes
no 
yes
no 

Additional Comments:
Please give any additional comments about the coverage you desire:

 

Thank you for your time in submitting this homeowners Proposal form. One of our representatives will respond to your submission as soon as possible!

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