Saucon Mutual Insurance Company

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FINANCIALS

SAUCON INSURANCE AGENCY

INLAND MARINE INSURANCE

ACTIVE IN THE COMMUNITY

OFFICERS and DIRECTORS

Renter's Quote

Name:

Home Phone:

Home Fax:

Work Phone:

Work Fax:

Email:

Mailing Address:

Mailing Address (Suite#):

City:

State:

Zip:

Township/Municipality/Borough:

County:

Insured Premises (If different):

Insured Address:

City:

State:

Zip:

Township/Municipality/Borough:

County:

Settlement Date:

Selling Price:

Mortgage Amount:

Number of Stories:

Year Constructed:

Construction Type:

How would you rate the overall condition of the home?

Do you have a fire alarm system?

Do you have...

Smoke Alarms? yes no

Dead Bolt Locks? yes no

Fire Extinguishers? yes no

Do you have a burglar alarm system?:

Is there a fire hydrant within 1000 feet of your property?

yes no

How many miles to the fire department?

Do you have a woodburning stove?

yes no

If yes, was it professionally installed?

Do you have a swimming pool?

yes no

If yes, is it fenced in with a locking gate?

Do you have any pets?

yes no

If yes, what breed and disposition?

Present Insurance Company:

Renewal Date:

Have you filed any homeowners claims in the last three years?

yes no

If yes, please describe the claim and amounts paid out:

If the house is over 20 years old, list the year when the following systems were last updated?

Roof:

Heat:

Plumbing:

Electrical:

Current Coverage Amount:

Contents:

Loss of Use:

Personal Liability:

Guest Medical Payments:

Deductibles:

Please email us your questions, comments or feedback. If your question concerns an existing policy, please provide the respective policy or account number for faster processing.

If you question is concerning a specific quote, please provide as much information as possible for an accurate quote.

NOTE - We will prepare a quote based upon your current policy dwelling coverage. Before issuing a policy, we must speak with you to prepare an updated dwelling cost estimator to verify the proper dwelling replacement value.

Saucon Mutual Insurance Company | 528 North New Street, Fourth Floor, Bethlehem, Pennsylvania 18018
E-mail: info@sauconmutual.com | Telephone 610- 868-1800 | Fax 610-317-0998