Home Questionnaire

Address For Home Quote

Quote Address *

Quote City *

Quote State *

Quote Zipcode *

Home Property Type (Check all that apply) *

I'm buying

I live or plan to live here

This is or will be my primary address

I'm using it as a seasonal property

I rent it out

Its an attached condo or townhouse

When do you want the policy to become active? *MM/DD/YYYY

Home Purchase Date (Approx. if not buying) *MM/DD/YYYY

Do you operate a business out of your home? *

Do you have any insurable interest in vacant land? *

Is the property in the course of construction? *

Does the residence have a wood burning stove? *

Will someone be living in the residence within 30 days of the policy becoming active?

Any security features? (Burglar, Fire Alarm, Sprinkler System)

Has your home had any renovations? When was the roof replaced?

Total Years of Continuous Home Insurance Coverage? *

Years Owned Quote Address (Primary)

Do you want 20% increased coverage on your dwelling coverage in case of inflation?

Do you want extra coverage for your house to be brought up to code on repairs?

All Perils Deductible except Wind & Hail

Wind And Hail Deductible

Family Liability Protection

Other structures Coverage (ex. Shed)

Personal Property Coverage

Medical Coverage if someone gets hurt at your home

Would you like water backup coverage? For sump pump failure, septic backup, clogged pipes

Do you have or looking to have scheduled personal property?

Do you own a second home/property? *

Secondary Home Information *

Address
City
State
Zip

Secondary Home Purchase Date (Approx. if not buying) *MM/DD/YYYY

Second Home: Do you operate a business out of your home?

Second Home: Do you have insurable interest in vacant land?

Second Home: Is the property in the course of construction?

Second Home: Does the residence have a wood burning stove?

Second Home: Will someone be living in the residence within 30 days of the policy becoming active?

Second Home: Any security features? (Burglar, Fire Alarm, Sprinkler System)

Second Home: Has your home had any renovations? When was the roof replaced?

Years Owned Quote Address (Second)

Same Coverages as Primary

Please press submit to complete home questions.

The Mello Agency serving MA & NH

Securing your today and tomorrow