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M - F, 7:00am - 6:00pm
(617) 389-9400
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CLIENT INFORMATION
Email:
Cell Number:
Work#:
Occupation:
AGENCY CLIENT CODE
Cell#:
Email:
Work#:
Occupation:
AUTO PROTECTION QUESTIONS
Does our agency insure ALL of your household cars?:
Yes
No
Have you acquired any new vehicles not listed on your policy?:
Yes
No
Are all licensed drivers in your household listed on your policy?:
Yes
No
Are there any licensed drivers a student with a B or above average?:
Yes
No
Are there any licensed drivers who have taken a defensive driving course?:
Yes
No
Are there any licensed drivers away at school?:
Yes
No
Are there any hybrid or electric vehicles?:
Yes
No
Are any vehicles garaged at another location?:
Yes
No
Are there any non-household residents that normally drive your car?:
Yes
No
Are there any vehicles used in connection with a business?:
Yes
No
HOME PROTECTION QUESTIONS
Does our agency insure ALL of your properties/home?:
Yes
No
Do you have a pool?:
Yes
No
Does your home have a central burglar or fire alarm?:
Yes
No
Have you done any significant renovations or additions in the last 3 years?:
Yes
No
Do you have a Temperature Monitoring Device?:
Yes
No
Do you Winterize your plumbing? (Discount of secondary homes):
Yes
No
Do you service your Heating Unit annually? (Discount on secondary homes):
Yes
No
Do you have a Hard-Wired Generator permanently installed?:
Yes
No
Does your Sump Pump have a Battery Backup System?:
Yes
No
Do you have a Water Leak Detection and Control System?:
Yes
No
Does your home have a Lightening Rod Protection System?:
Yes
No
Do you have Hurricane Shutters?:
Yes
No
Do you have a Shatter Resistant or Hurricane Proof Windows?:
Yes
No
Do you run a business from your home?:
Yes
No
DO YOU OWN ANY OF THE FOLLOWING
Check all that apply
Any Collector Items
Art Work
ATV
Baseball Cards
Golf Carts
Golf Clubs
Guns
Jet Ski
Over $5,000 in Jewelry
Moped
Musical Instruments
Snowmobile
HOUSEHOLD UPDATES
What year was your heating and cooling system last updated?:
What year was your roof last replaced?:
What year was your plumbing replaced?:
What year was your electric last updated?:
GENERAL QUESTIONS
Do you have any specific questions on an area of insurance that we may research for you? Comments:
Do you have any suggestions on how we could improve the Agencys Service?:
Do you have any specific expectations or special requests we may work on for you?:
Other than price, what is most important to you when it comes to Insurance? Please select a number 1 through 4 (1 being the most important)
Agency Service:
1
2
3
4
Insurance Company:
1
2
3
4
Protection of Assets:
1
2
3
4
Claim Service:
1
2
3
4
Get a Quote
or call
617-389-9400
Find out more
Personal Insurance
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Mailing Address
220 Broadway Suite #304
Lynnfield, MA 01940
BUSINESS HOURS
7:00am - 6:00pm
Everett Lobby Hours:
8:30am - 4:00pm
Lynnfield Lobby Hours:
8:30am - 5:00pm
Everett Office
629 Broadway
Everett, MA 02149
(View Map)
Lobby Hours:
8:30am - 4pm, M - F
Phone: 617-389-9400
Fax: 781-584-4445
Lynnfield Office
220 Broadway Suite #304
Lynnfield, MA 01940
(View Map)
Lobby Hours:
8:30am - 5pm, M - F
Phone: 781-596-0033
Fax: 781-584-4445