James R Meys Agency, Geneseo, NY | Homeowner Insurance Quote Request

This application process will allow you to request a quote for homeowner's insurance.

This is some information you should have available to complete the application:

   1) Zip Code of the insured home
   2) Value of the home
   3) The year that the home was built

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Note: Questions marked in red are required items and must be answered
prior to clicking submit.

Referrer's Name:
Name:		Phone:
Mailing Address:		E-Mail:
		SS#:
Property Location:
City/Town:	, NY Zip:	County:
Current Coverage's

Dwelling:		Liability:
Other Structures:		Medical Payments:
Personal Property:
Loss of Use:


Deductible Desired:
Year Constructed:
Number of Family:
Construction Type:

Please answer the following questons: (Explain all "Yes" answers in the remarks section below)
1.	Any other structures (garage, storage building, residence etc.) on premises?	Yes	No
2.	Any insurance declined/canceled or non-renewed in the last three years?	Yes	No
3.	Are there any other type of heating devices used other than central?	Yes	No
4.	Do you have any other insurance with this company?	Yes	No
5.	Swimming pool on premises?	Yes	No
	Fenced In Ground Above Ground
6.	Any animals on premises?	Yes	No
	Number and Breed:
7.	Wiring: Year of last update? Circuit Breakers:Fuses:
8.	Plumbing: Year of last update? Copper Pipe: PVC:
9.	Roof: Year of last update? Shingle: Rubber: Metal: Rolled Roof (Tarpaper):
10.	Heating: Year of last update? Cleaned/maintained at least once per year?	Yes	No
11.	Any claims in the last five (5) years?	Yes	No
12.	Who is the responding Fire Department
13.	Is the home a townhouse?	Yes	No
14.	Are there any smoke alarms in the home?	Yes	No
15.	Do you own any recreational vehicles, such as a snowmobile or a boat?	Yes	No

Enter any remarks here

Please ensure that all questions marked in red have been answered prior to clicking submit.