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Higinio Agency
.304.422
 
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Higinio
Higinio Agency
Higinio
Higinio
       
 

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Homeowner's Insurance *Required Fields
Insured's Information
First Name*
Last Name*
Address 1*
Address 2
City*
State*
  Zip*
Phone*
- -
Email
Occupation
Birth Date*
/ /
Social Security Number
- -
How Long at Current Address?* years
If Less than three Years
(previous Address)
     
Dwelling Information
Dwelling Type*
  # of Stories
Dwelling Use*
Purchase Price*
$ .
Year Built*
Construction Type*
Type of roof*
Heating*
  Oil Tank Location*
Interior Walls & Ceiling*
% Drywall   % Plaster   % Painted   % Paneled   % Tiled
Floors*
% Hardwood   % Parkae   % Carpeted   % Tiled
Year Renovated*
Wire   Plumbing   Heat   Roof
Number of Rooms*
Bathrooms: Full   Half Bedrooms   Kitchens      
Basement
Sq. ft.  
Garage
No. of Cars    
Attic
Sq. ft.  
Fireplaces
How Many?  
Porch
Sq. Ft.    
Alarms
Burgarlar   Fire   Sprinkler System   Dead Bolt   Smoke Alarm
Central Air*
Yes   No   Separate Ducts from Heat? Yes   No
Animals*
Yes   No   What Kind
Do You Smoke?*
Yes   No  
Do You Have a Mortgage?*
Yes   No  
Mortgagee
     
 
   

 

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January 22, 2011
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4th Floor
White Plains, NY

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Higinio Agency
75 S. Broadway | White Plains, NY | 10601

Call us TODAY 914.304.4222
info@HiginioAgency.com