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Atlantic Insurance Services will give you what you pay for...insurance knowledge, insurance expertise and prompt service. Above all, we get paid to provide results - not excuses.
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Homeowners Insurance Quote
Please fill out this form to receive an online quote.
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General Information
Contact Name *
eMail *
Phone Number *
Mobile / Cell Number
Property Location
Address 1 *
Address 2
City *
State *
Zip Code *
Current Insurance
Company Name
Current Annual Premium
Expiration Date
Deductible
$500
$1000
$2000
Amount of Liability
$300,000
$500,000
$1,000,000
Earthquake Coverage?
Yes
No
Flood Coverage?
Yes
No
Have you filed for backruptcy within the past 7 years?
Yes
No
Describe any claims in the last 5 years
Dwelling Information
Dwelling Value
Estimated Replacement Cost
Square Footage
Year Constructed
Type of construction
Frame
Stucco
Masonry
Brick Veneer
Electrical Updated
(MM/DD/YY)
Roof Updated
(MM/DD/YY)
Plumbing Updated?
(MM/DD/YY)
Heat Updated?
(MM/DD/YY)
Type of Heat
Other Features (Check all that apply)
Deadbolts
Smoke Detectors
FireExtinguisher
Central Station Fire Alarm
Central Station Burgler Alarm
Home located within 5 miles of fire station
Home located within 1000 feet of a fire hydrant
Swimming Pool
Pets
Trampoline
Home located within 2 miles of tidal water
Jewelry Owned
Furs Owned
Disclaimer Notice -
The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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