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Home Insurance Form

Is there a 2nd person listed on the deed?
Yes No
How did you hear about Greylock Insurance Agency?
 
Are you a Greylock Federal Credit Union Member?
Yes No
Home, Cell, or Work

What is your Current Address?

Location you want to insure:

Check if address is the same as your Current Address
 
Is this a new purchase?
Yes No
Are you moving in within 30 days of the closing date?
Yes No
Do you have current insurance on the property?
Yes No
Have you ever been cancelled or nonrenewed for any reason?
Yes No
Upload document near the end of the form
Will this be your:
         
Will you rent any portion of the house out during the year?
Yes No
Does the home have any unrepaired damage or areas that need repair or replacement?
Yes No
Type of home:
       
Construction type:
 
What kind of siding?
 
Basement?
Yes No
Any portion of the basement finished?
Yes No
What type of roof is on the house?
           
Is the roof flat?
       
What is the primary source of heat?
         
Secondary heat source?
Yes No
Secondary heat source is:
         
Is there a fireplace?
Yes No
What type of electrical system?
select all that apply
 
Example: Remodeled a room, replaced fixtures or outlets, added an addition, etc
Knob and tube wiring?
Yes No
What type of plumbing?
 
Example: Remodeled a room, replaced fixtures, added an addition, etc
Radiant flooring?
Yes No
Is there a garage on the property?
Yes No
Make selection
     
Any living space in the garage?
Yes No
Any other structures on the property?
Yes No
Make selection
check all that apply
 
Any attached structures to the house?
check all that apply
 
Solar panels?
Yes No
Are they leased or owned?
     
enter number
enter number
How would you best describe your bathrooms?
       
How would you best describe your kitchen?
       
Is the home within 1,000 feet of a fire hydrant?
Yes No
Is the home within 5 miles of a fire station?
Yes No
Do you have a burglar or fire alarm?
Yes No
Does it notify an alarm company or police department?
Yes No
Do any household members smoke?
Yes No
Do you have any pets?
Yes No
Make selection:
check all that apply
 
Has the dog(s) ever bitten anyone?
Yes No
Do you have any farm animals?
Yes No
Is there a trampoline?
Yes No
Does it have a net?
Yes No
Is your yard fenced in?
Yes No
Is there a Hot Tub on the property?
Yes No
Is there a Pool on the property?
Yes No
Type of pool:
     
Is the entire pool fenced in?
Yes No
Do you have a diving board or slide?
Yes No
Is there a locking or removable ladder?
Yes No
Do you own any of the following?
check all that apply
 
Do you have any items such as jewelry, artwork, silverware, firearms, or collectibles that you would need more than $2,000 in coverage for?
Yes No
Do you run a home daycare?
Yes No
Do you carry a separate daycare policy?
Yes No
Do you run any other type of business out of your home?
Yes No
Have you made any claims on your home insurance in the last 6 years?
Yes No
Would you like a quote for life insurance to cover your mortgage, family or any other commitments you have?
Yes No
You received additional discounts by having your home and auto insurance with Greylock Insurance.
Do you have any auto insurance policy you would like us to quote?
Yes No

We need a few more things to accurately quote your home insurance with all of our carriers. Please upload a copy of your current home insurance policy and a few photos of your home so we can get started. For the photos, we need the outside only, and we need to be able to see all four sides. Please also include a picture of any other structures on the property.

maximum of 4 files

Would you like a quote for a personal umbrella excess liability policy?
Yes No
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