Welcome To Borden Insurance Agency, Inc.

CUSTOMER SERVICE DESK

Our Agency Quotes Resources Contact Us

Home/Tenant/Condo Insurance Quote Form

Please complete the form below for a quote. Fields marked with an "*" are required.

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Preferred delivery of your free quote:

Phone Number:		Fax Number:
E-Mail Address:		Date current policy expires:

Coverage Questionnaire

Type of Coverage Desired:

Homeowners Policy

Tenant Policy

Condo Policy

Type of Construction:

Frame

Brick

Year Built

If your home is over twenty five years old, please fill in the year of any significant updates to the following:

Electrical		Plumbing
Heating		Roof

Number of apts. units in the building:

Does your home have:

Smoke Detectors

Monitored Burglar Alarm

Amount of Coverage on Dwelling:

Amount of Contents Coverage ( For Tenants or Condo Policy Only):

Liability Coverage:

$300,000

$500,000

$1,000,000

Do you own a dog?

if Yes, what breed

Do you have items listed separately? (i.e. jewelry, fine arts, furs)

Property Deductible Desired:

Have you had any homeowners claims in the past five years:

May we run an insurance score?

(An insurance score is a cursory pass-fail credit check and prior claim review)

How did you hear about us:

Please specify: