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Home Quote Proposal


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Who referred you to M&A?
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Preferred phone number
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E-Mail Address
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First Name
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Last Name
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Name / number of lender assisting in the loan process if property is financed
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What is you and your spouse’s or significant others full legal name?
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Date of birth for both of you?
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Driver’s License numbers and state issued?
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Property address of the home needing to be insured?
Street
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City
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State
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ZIP / Postal Code
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What is your purchase price/ loan amount?
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What is your current address?
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Do you have any pets? If so, what kind/breed?
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Do you plan to have a monitored alarm in your new home?
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What is the anticipated closing date of the new home?
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Occupations for occupants in the household
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Date needed insurance to take effect or to be active for home closing?
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Also, we work with about 15 different A+ Rated insurance carriers. Most of them offer a discount between 25-35% on the home insurance by packaging the auto and home coverage together. I usually like to weigh out that option while we are preparing the home proposal. With that being said: (if you don't know the specifics; no worries - I should be able to pull up most auto details)
What is the year, make, and model of your vehicle(s)?
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Current auto insurance company name?
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Do you carry comprehensive and collision coverage?
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Do you happen to know your deductibles?
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Rental Car and towing coverage needed?
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How many drivers are in the household?
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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