Hollis Insurance Agency, Inc.

1 Village Green North, Suite 121
Plymouth, MA 02360

Phone: 508-209-0400     Fax: 508-209-0444

Please be advised that insurance coverage cannot be bound, modified, or terminated by e-mail messages or information provided to us via the web. Any information you submit will be used solely for the purpose of quoting insurance options, and does not in any way constitute an agreement of coverage.

Requests received via normal business hours will be processed within 48 hours - sooner when possible. Please call us if you need immediate help.

Home/Renter/Condo Insurance Quote

Full Name: Email:
Mailing Address: City:
Street Address: (if different) State: Zip:
Home Phone: (with area code)
 Work Phone: (with area code)
Ext:
Fax: (with area code)
Best time to contact:

  1. Select the type of policy you would like a quote on:

  2. What is the current expiration date of your existing policy?

  3. If insured, name of company insured with:

    * If a renter, skip to question #10

  4. Current residence status:

  5. Do you ever rent your property?

    Yes No

    If yes, for how many weeks per year?

  6. Is this a primary or secondary home or rental property? (choose one)

  7. Do you need special coverage for jewerly, fine art, antiques, silverware, furs, computers, or other items?

    Yes No

    If yes, please list items and approximate value

  8. Homeowners or Condo (coverage A on existing policy)

    Amount of coverage on dwelling (i.e. $150,000): $

  9. Other Structures (coverage B on existing policy)

    Yes No

    If yes, state value:

  10. Personal Property (coverage C on existing policy)

    Amount of coverage on personal property (i.e. $25,000 - Minimum of $15,000): $

  11. Loss of Use (coverage D on existing policy)

    Amount of coverage: $

  12. Personal Liability (coverage E on existing policy):

  13. Deductible Amount

  14. Construction Type

  15. Approximate year residence was built (i.e. 1977)

    What is the square footage of the property you want insured?

    Age of roof? (i.e. 1977)

    Approximate distance from fire department, in miles?

    Type of electrical system:

  16. Type of heat:

    If oil heat, is there an underground oil tank? Yes No

  17. Check all that apply

    Smoke Detectors
    Swimming Pool If yes: Diving Board? Yes No | Fenced? Yes No
    Central Burglar/Fire Alarm Name of Monitoring Company:
    Trampoline
    Dogs or Horses If yes, name breed:
    Wood, Coal, Pellet Stove
    Garage attached detached none
    Deck Porch
    Basement Attic
    Fireplace

  18. Are you or your spouse over 55 years of age?

    Yes No

  19. Do any household members smoke?

    Yes No

  20. Any business conducted on premises?

    Yes No

    If yes, please describe

    21. Claims/Loss Information

  21. Please describe any claims or losses you've had in the past 3 years.

  22. Have you ever been cancelled or non-renewed for any reason?

    Yes No

  23. Discount Information

    Most insurance companies provide a 10% discount on your homeowners policy if you insure your vehicles and residence with them.

    Would you be interested in this discount? Yes No

  24. Questions and/or Comments

sixty divided by = 15

Requests for insurance information received during regular business hours are processed within 48 hours - often much sooner if possible. Thank you!

Important Note: Quotes will be based on the information provided. It is only a rate calculation and is not binding in any way. A full application must be completed and signed by the named insured.