Generazio Associates, Inc.

Home Owners Insurance Quote

For the quickest and most accurate insurance quote, please provide as much information as possible in the form below.

THIS INFORMATION WILL BE KEPT CONFIDENTIAL
AND WILL BE USED FOR QUOTING PURPOSES ONLY!

Contact Information

SAME DAY COVERAGE FOR CLOSINGS

Name:

Address:

City:

State:

Zip Code:

County:

Social Security #:

For credit check by insurance companies
for quoting purposes only

Date of Birth:

(mm/dd/yyyy)

Within City Limits:

Yes No

Phone #:

Cell #:

Work #:

Best Time To Be Reached:

Email:

Discount for Home + Auto Package (up to 24 % disc):

Yes No (If yes fill out our Auto quote sheet)

New Purchase closing date:

(mm/dd/yyyy)

Purchase Price:

Time at Current Residence:

Yr. Mo.

Time at Previous Residence:

Yr. Mo.

Current Ins. On Property:

Yes No

Rent:

Yes No

Company Name:

Renewal Date:

Coverage Reguested:

Appraisal Value:

Deductible:

Liability Limits:

Property Description

Construction Type:

Style:

Year Built:

Approx Sq Ft:

Number Of Bedrooms:

# Of Floors:

Kitchens:

# Bathrooms:

# Of Half Bath:

Basement:

Attic:

Roof Type:

Peaked-Flat:

Age:

Garage Type:

Heating System:

OIL TANK LOC:

Electric:

# Of Amps:

Circuit Breakers Fuses

Year Updated

Wiring: (mm/dd/yyyy)

(mm/dd/yyyy)

Heating:

(mm/dd/yyyy)

Plumbing:

(mm/dd/yyyy)

Roof:

(mm/dd/yyyy)

Additional Info

Alarms:

Fire Ext. Dead Bolt Sprinkler

Pool:

Trampoline:

Yes No

Pets if so: breed/age/gender/name

Claims:Type, Date of Loss, Amount Paid Out

Additional Information:

Feedback:

Suggestions on how can we
improve our quote sheets

Generazio Associates, Inc.
265 Broad Street Bloomfield, NJ 070073 Phone: 973-429-8100 Fax: 973-429-9763	515 Washington Road Parlin, NJ 08859 Phone: 732-257-2600 Fax: 9732-257-7921