Renter's Insurance Quote Form

To receive a Quote for Homeowner's Insurance, please fill out the following form and click the "Request Quote" button at the bottom of the form to submit your information to John J. Prudente Agency.  One of our agents will contact you shortly.

You may use your tab key or your mouse to move through the form.

Contact Information
 Name:
Mail Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Fax:
Email Address:
What is your preferred form of contact to receive your quote?


If by phone, best time to call:

I Would Like A Competitive Quote
Based on my CURRENT POLICY which expires: 



Insurance Carrier:
For a NEW RENTAL, date:


Desired Coverages
E. Personal Liability:
C. Personal Property ($):
15,000 minimum
F. Medical Payments:
Deductible Amounts:

Personal Umbrella Liability:

How many vehicles?

 
Number of  Apt. Claims
in the Last 3 Years
(please describe--loss type, date & amount paid):
Information About Your Apartment
Location of Apartment:
(if different from that address above)
Year Built:
Total Units in Apartment:
What floor is apt?
Basement
First
Second or higher
Construction:

Non-Smokers:
Yes  No

Alarm Systems:
Central Burglar
Central Fire

Monitored by Central Station?
Yes  No

Safety Systems:
Smoke Detector
Deadbolts
Fire Extinguishers
Sprinklers

Account Credit Eligibility

What insurance company writes your MA auto insurance?


Renewal Date:

 

 
Is application complete and ready to submit? 
Yes


       

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