Florida Homeowners Insurance Quote from Cronin Insurance.com

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Internet Sales & Service from Florida's Insurance Leader!

Homeowners Insurance Quotation Form One Simple Form - takes only 2-3 Minutes! Your Personal Data:

Your Name:
Property Address:
City:
State:	Must be Florida
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):

Many Carriers Now Use Credit Scoring For Rates and Discounts. How would you honestly rate your credit strength & past payment history?	Perfect Fair Poor No Past Credit


Dwelling Information

Year Home Built:

Home Square footage:

Is this your primary home, secondary home, or seasonal home?

Is this Builder's Risk? (new home constr.)	NO YES

Month/Year home to be complete:

Number of units: (We can write owner occupied homes up to 4 units)	1 family Duplex 3 Units 4 Units

Construction Type:	Frame Masonry/CBS Fire resistive

Type foundation:	Slab Crawlspace over slab Pier & Post Other (list in remarks)

Type Roof:	Shingle Wood Shake Tar/Gravel Spanish Tile Metal Other

Type Garage:	None Built in Attached Detached

How Many Car Garage?

Number of stories:	One 1.5 Two Three

Do you own animals or pets?	Yes No
If yes, list type/for dogs, list breed:

Are You Near Brush Area?	Yes No
# of feet to nearest fire hydrant:	# of miles to nearest fire station:

Currently Insured?	Yes No
If yes, list Carrier Name, and Expiration Date of current coverage:

Do you have a swimming pool?	Yes No
Is Pool Fenced?	Yes No
Does Pool have screened enclosure?	Yes No

Prior Claims?	Yes No
Describe claims in detail:

Plumbing type:	Copper Galvanized Mixed (Copper/Galvanized)

Circuit Breakers or fuses?	Breakers Fuses

# Bedrooms: # Bathrooms:

# Fireplaces: # Chimneys:

Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)

Coverages:

Dwelling Cov. $ Contents $

Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)

Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):

Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!
We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Cronin Insurance Agency
11395AA West Palmetto Park Road
Boca Raton, FL 33428
Toll Free: 1-888-427-6646
Phone: 1-561-479-1898
Fax: 1-561-479-1386
E-Mail: petercronin@cronininsurance.com
Web Site: www.cronininsurance.com


Terms of Use/Privacy Notice/Copyright Info. Cronin Insurance Agency. Design © 2005 Insurance-Web-Sales Please report site-related technical problems to: petercronin@cronininsurance.com (This page last updated March 30, 2005)

# Bedrooms:		# Bathrooms:

# Fireplaces:		# Chimneys:

Special features (i.e., deck, air conditioning, alarm systems, pool, etc.)

Coverages:

Dwelling Cov. $		Contents $
Liability Cov. $		Deductible $ ($250, $500, $1,000, etc.)

Comments/Remarks (describe any scheduled jewelry, in-home business, or other special coverages needed here):

Send my quotation via:		E-Mail Fax Regular Mail Call Me By Phone