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TANNER-IBBOTSON, Inc.

1109 Commons Avenue      Cortland, NY 13045    607.756.7531

Your Local Independent
Insurance Agency

Home Insurance Contact Form

Let us provide a quote for you

We have several companies to choose from to provide the most suitable coverage at the best possible rate.

Once we receive your information, we will determine the replacement cost value of your house. If possible, we will have our inspector contact you in order to come out to get an exterior picture of your house and exterior dimension.

We will quote the best homeowners program we have based on your needs. Ideally, we would quote the coverage on the house at 100% of replacement cost. We ask a lot of questions. The answers are all important and let us do the best possible job for you.


  Please fill out the contact information below:  
  First Name*
  Last Name*
Occupation
Address
  City  
  State  
  ZIP  
Country
Home Phone
  Work Phone  
Fax
  E-Mail *  
       
  Location of house if different than above    
  Address:  
 
Current Coverage
     
  Current Insurance Company Name:  
  Expiration Date of Coverage Date:  
  Years with Current Company Number:  
  Current cost of insurance per year Amount:  
  Has the applicant ever had any insurance declined, cancelled, or non-renewed within the last five years Choose:  
  Has the Applicant Purchased Personal Life Insurance Choose:  
  Age of house/ Year Built Year:  
  Purchase Date Date:  
  Purchase Price Dollars:  
  Family Members Number:  
  Number of Families Number:  
         
  Number of Stories Number:  
  Occupancy Choose:  
Construction Type Choose:
  Garage Type Choose:

Number of Cars: 
 
 
 
  Electrical Choose:  
Renovations:
  Roof Choose:  
    Date Replaced:  
  Foundation Type Choose:  
  Heating System Choose:  
Renovations:
Supplemental
Heating Units:
    Age of Unit:  
Plumbing Types Choose:
Renovations:
  Hydrants Choose:  
  House Visible from Three Neighbors Choose:  
  To establish replacement value, we would like to get a listing or the rooms by floor:   
   
     
Porch Choose:
Deck Choose:
Full Basement Choose:

Finished off:
 
  Wood Stove Choose:
Professionally installed: 
 
 
  Fireplace Choose:  
  Attic Choose:

Finished Off::
 
 
  Smoke Alarms Choose:  
  Fire Extinguishers Choose:  
  Security Alarms Choose:

24-Hour Central Station: 
  
 
  Dead Bolt Locks Choose:  
  Do you Smoke Choose:  
  Do you Own Pets Choose:

What Breed:

Bite history:
 
 
 
Swimming Pool Choose:

Pool Type: 
  
  Own other Property Choose:  
  Recreational Vehicles Choose:  
  Business Exposure
(ie. Office/Studio)
Choose:  
  Provide Day Care in Home Choose:  
Trampoline or any other
outdoor rec equipment
Choose:
Interested in Homeowners,
Condominium or Renters Coverage
Choose:
         
  Collectables such as Jewelry, Furs, Guns (Please List)  
   
     
         
  Square Footage of the Home Feet:  
  Desired Amount of Coverage Dollars:  
Describe the Losses in the Last 3 Years Describe:
Are there other structures on the premises Describe:
  Are there any other residence owned, occupied or rented Describe:  





 
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Copyright © 2011-15 Tanner-Ibbotson, Inc. All Rights Reserved.
1109 Commons Ave., Cortland, NY 13045
Phone: (607) 756-7531 Fax: (607) 753-3050
Inquire@TannerIbbotson.com

 

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