Bouvier Beckwith & Lennox Insurance
Home
Contact
About
Partners
Personal Insurance
Commercial Insurance
Condominium Master Insurance
Request a Certificate of Condominium Master Insurance
Life & Health Insurance
CT Resturant Association

Bouvier Beckwith & Lennox
West Hartford, CT
P 860.232.4491

Root Insurance Agency
East Haddam, CT
P 860.873.8606

E.R. Champion & Son
Old Lyme, CT
P 860.434.1611

Bourgoin Insurance Agency
East Windsor, CT
P 860.623.8207

Clarke Insurance Agency
Manchester, CT 06040
P 860.643.1126

I.F. Mathieu Insurance Agency
Norwich, CT
P 860.887.1617

Home Insurance Quote Request

Use this form to request a home insurance quote, and we will contact you promptly.

Check here to allow us to run an insurance score.
This allows us to determine the best pricing tier for you

Your Information

Name*
Telephone*
Email Address

Current Address

Mailing Address*
City*
State*
Zip Code*

Previous Address

Mailing Address*
City*
State*
Zip Code*

General Information

Check here if you've had bankruptcy, tax lien, sustained any judgment, foreclosure, or repossession.
Will you live in the house?
Yes   No
Will this be escrowed?
Yes No
If new purchase:
  Price:
  Mortgage Amount:
  Closing Date:
Are you insured by us?
Yes No
If no, referred by?
Construction Type:
Frame Brick Any Stucco
Other
Style of Home:
Year Built:
No. of Stories:
Total Sq Ft:
If/when were the following updated over the last ten years?
  Plumbing:
  Electrical:
  Heating/Furnace:
  Roof:
  Flat Roof:

Specfic Home Information

  Yes No  
Basement SQ FT
Walkout  
Finished  
Unfinished  
Garage # of Bays
Detached  
Attached  
Built in  
Basement  
Carport  
Deck SQ FT
Porch SQ FT
Enclosed  

Heat Type

Gas
Electric
Oil
Other

More Details

Fire Protection Device
Smoke detector
Fire extingisher
Local Alarm
Central station alarm
Burglar Alarm
Deadbolt
Hydrant
Within 500 feet
Within 1000 feet
Over 1000 feet
Miles from Fire Station
Anyone Smoke?
Any Animals? (Breed)
Bite History
Pool
Inground
Above ground
Fenced
Diving board
Slide
Trampoline

How many of the following?

Baths
Any Other Special Features?

 

HOME | CONTACT | ABOUT | PARTNERS | PERSONAL INSURANCE | COMMERCIAL INSURANCE |
CONDOMINIUM MASTER INSURANCE AND CERTIFICATES | LIFE & HEALTH INSURANCE | CT RESTAURANT ASSOCIATION
Copyright © 2006 Bouvier Beckwith & Lennox, Inc. All Rights Reserved. Privacy Policy.