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   166 Winthrop Ave. Revere MA 02151 781-284-8783, fax 781-289-4451

Lattanzi Insurance Agency is licensed to sell insurance in the state of Massachusetts.   If you are not a resident of Massachusetts, or if the exposure you wish to insure is not in the state, we will be unable to provide you a quote.  Quotes provided from this form are estimates only.  These quotes are subject to change upon formal application and additional information obtained or revised.  Lattanzi Insurance Agency accepts no responsibility for electronic piracy, etc., when any information is submitted electronically.  Completing and submitting the following information indicates understanding and acceptance of these terms and conditions.  Submission of application information does not obligate you to purchase any product or insurance, nor does it represent any agreement to provide coverage under any insurance policy.

Homeowners Insurance Quote Form

wpe7.gif (2088 bytes) for a quick comparison quote, fax your current policy to
(781) 289-4451 or email Peter@Lattanziinsurance.com

Please provide the following contact information:

Name

Address
City
State (Mass. Only) Zip

Property location if different
Type of policy
Current Company
Expiration date
Contact Via
Work phone
Home phone
Fax

Email

Please provide the following property information:

Number of families
Year built
Square feet of living space
Construction type
Distance to water
House for sale
Swimming pool
Smoke Detectors
Fire extinguishers
Alarm system
Electrical system
Heating system
Plumbing system
Roof type
Age of roof
Outside Trampoline on premise?
Undergoing renovation or reconstruction
Please list any pets

Select any of the following that apply:

In home business(s)
Full time residence employee(s)
Property on more than five acres
Underground oil tank
Wood burning stove
Greenhouse
Own recreational vehicle (example: snow mobile, mini-bike, dune buggy, atv, etc...)
Been convicted of any degree of arson during  last  ten years
Had insurance declined, cancelled or  non-renewed during last three years
Had foreclosure, repossession or bankruptcy during last seven years

Please provide the following insurance information:

HOMEOWNERS ONLY: Dwelling limit
TENANTS ONLY:Contents limit
CONDO ONLY: Contents limit
Liability limit
Deductible

Replacement cost on Dwelling (homeowners only)

Replacement cost on contents

Umbrella coverage

Is there currently a policy in effect?
If yes, what is current amount of insurance
If no, what is replacement cost of property

Please list all liability or property losses:
(include date, type and amount)