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Condominium Owners Insurance Request for Quote*

*Please Note: Submitting this quotation request does not bind coverage

Fill in the form below with as much of your information as possible. Field marked with an '*' are required.

Owner’s Name (First, Middle, Last):*

Date of Birth:*
Co-Owner’s Name (First, Middle, Last)
Date of Birth:
Address:*
City:*
State:*
Zip:*
Home Phone #:*
Work Phone #:
Email:*
Fax #:
Best time to call: Morning Afternoon Evening
Best way to reach: Phone Fax Email
Property Address if different from above -- Address:
City:

State:

Zip:
Residence Information:
Is this a primary or secondary residence?:* Primary Secondary
Approximate Year of construction:
Is the condominium rented to others?:*
 Yes No
Type of Construction:
Any Losses in the last three years?: Yes No
Non-Smoker?: Yes No
Are all members of your household non-smokers?: Yes No
Does the condominium have a swimming pool?: Yes No
Do you own a dog?: Yes No
Breed:
If your condo is older than  36 years, have the following systems been updated (check if yes):
Plumbing Electrical Heating Roof
Coverage Information:
Condo Dwelling:
Personal Property/Contents:
Personal Liability:
Medical Payments:
Deductible:
Loss Assessment:
Endorsements/Optional Coverages:
Replacement cost on coverages? Yes No
Do you have the following Protective Devices (check if yes):
Central Station Burglar Alarm
Central Station Fire Alarm
Smoke Alarms
Automatic Sprinklers
Police Station Direct Alarm
Fire Extinguishers
Fire Station Fire Alarm
Deadbolts
Scheduled Property (Enter an amount for all that apply)
Golf Equipment:
Cameras:
Musical Instruments:

Silverware:

Furs:
Guns:
Jewelry:
Fine Arts:

 


A member of Renaissance Alliance Insurance Services.

Markham Priest Insurance • 20 Central Ave. • P.O. Box 310 • Ayer, MA 01432
Phone:  1-800-971-0800 • Fax:  978-772-9506
Office Hours • Monday - Friday: 8:00 am - 5:00 pm or By Appointment
To learn more about Markham Priest Insurance, please download our company brochure.

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