Germani Insurance Agency

Homeowner's Quote Information

If you currently reside in Massachusetts or are considering a move to this area in the future, please complete the information below for a quote.

Please be advised that the Germani Insurance Agency cannot bind, modify or terminate coverage by messages left on our online quote system or by messages sent by email.

General Information

Your Name:
Phone #:

E-mail Address:

Mailing

Address:

City:

State:

Zip:

Property (to be insured)

Address:

City:

State:

Zip:

The Germani Insurance Agency can only quote Massachusetts homeowner's insurance requests from this Web Page.

Coverage Amounts

Dwelling Coverage $:
Personal Property Coverage $:
Liability Limits $:
Medical Payments $:	per person
Deductible Amount $	per occurrence

Any Scheduled Property (Jewelry, Coins, Collectables, Furs, etc.):

Construction and Other Information

Year of Construction:

Dwelling Construction:

Frame Brick/Masonry

Is there a Swimming Pool on the Premises:

Yes No

Distance to a Fire Department:
Distance to a Fire Hydrant:
Fire District (if known):

In City Limits:	Yes No
	What City:

Miscellaneous

Any Pets:

Yes No

If yes...

Describe pets and how many:

Any other homes owned?

Yes No

If yes...

Describe location and structure:

Previous Insurance History

Any Losses in last 5 years:

Yes No

If yes...	Describe Loss
	Date of loss:
	Amount of loss:

Have you ever had any coverage canceled or declined for any reason?

Yes No

If yes...

Explain:

Current Homeowner's Insurance Company

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Thank you for completing the Homeowner's quote form.
Please click on the Submit the Form button above
to submit the information to a Germani Insurance agent.

A Germani Insurance agent will review your information and contact you with a quote.

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