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Home Insurance Form

Please complete the information below to obtain an home insurance quote. We write with multiple carriers and we will use this information to find the best fit for you!




Is there a 2nd person listed on the deed?

Yes
No
 



How did you hear about Greylock Insurance Agency?

Online
GFCU Member
Friend/Family
Other
 

Are you a Greylock Federal Credit Union Member?

Yes
No
 

Home, Cell, or Work

What is your Current Address?





Location you want to insure:

Check if address is the same as your Current Address

Same as Current
 




Is this a new purchase?

Yes
No
 



Are you moving in within 30 days of the closing date?

Yes
No
 
Will there be a mortgage?

Yes
No
 


Do you have current insurance on the property?

Yes
No
 

Have you ever been cancelled or nonrenewed for any reason?

Yes
No
 

Upload document near the end of the form
Will this be your:

Primary Home
Secondary Home
Rental Property
Vacant Property
 
Will you rent any portion of the house out during the year?

Yes
No
 

Does the home have any unrepaired damage or areas that need repair or replacement?

Yes
No
 


Type of home:

Single Family
2 Family
Multifamily (3 or more)
 
Construction type:

Frame
Brick
Log
Other
 
What kind of siding?

Vinyl
Aluminum
Wood shakes
Asbestos
Other
 

Basement?

Yes
No
 
Any portion of the basement finished?

Yes
No
 

What type of roof is on the house?

Asphalt shingles
Architectural shingles
Metal
Slate
Other
 

Is the roof flat?

Yes
No
Partially
 

What is the primary source of heat?

Oil
Gas
Electric
Propane
 

Secondary heat source?

Yes
No
 
Secondary heat source is:

Woodstove
Pellet stove
Coal stove
Other
 



Is there a fireplace?

Yes
No
 

What type of electrical system?

select all that apply
Fuses
Circuit breakers
 


Example: Remodeled a room, replaced fixtures or outlets, added an addition, etc
Knob and tube wiring?

Yes
No
 

What type of plumbing?

Copper
PVC
PEX
Other
 



Example: Remodeled a room, replaced fixtures, added an addition, etc
Radiant flooring?

Yes
No
 

Is there a garage on the property?

Yes
No
 
Make selection

Attached
Detached
 

Any living space in the garage?

Yes
No
 
Any other structures on the property?

Yes
No
 
Make selection

check all that apply
Barn
Shed
Gazebo
Other
 

Any attached structures to the house?

check all that apply
Deck
Breezeway
Open porch
Enclosed porch
Other
 

Solar panels?

Yes
No
 

Are they leased or owned?

Leased
Owned
 



enter number

enter number
How would you best describe your bathrooms?

Basic features
Some custom features
Mostly custom features
 
How would you best describe your kitchen?

Basic features
Some custom features
Mostly custom features
 
Is the home within 1,000 feet of a fire hydrant?

Yes
No
 

Is the home within 5 miles of a fire station?

Yes
No
 
Do you have a burglar or fire alarm?

Yes
No
 
Does it notify an alarm company or police department?

Yes
No
 
Do any household members smoke?

Yes
No
 
Do you have any pets?

Yes
No
 
Make selection:

check all that apply
Cat
Dog
Bird
Ferret
Other
 




Has the dog(s) ever bitten anyone?

Yes
No
 
Do you have any farm animals?

Yes
No
 


Is there a trampoline?

Yes
No
 
Does it have a net?

Yes
No
 
Is your yard fenced in?

Yes
No
 
Is there a Hot Tub on the property?

Yes
No
 
Is there a Pool on the property?

Yes
No
 
Type of pool:

Inground
Above ground
 
Is the entire pool fenced in?

Yes
No
 
Do you have a diving board or slide?

Yes
No
 
Is there a locking or removable ladder?

Yes
No
 
Do you own any of the following?

check all that apply
Snowmobile
ATV
Golf cart
Skate ramp
Tree house
Zip line
None
 
Do you have any items such as jewelry, artwork, silverware, firearms, or collectibles that you would need more than $2,000 in coverage for?

Yes
No
 

Do you run a home daycare?

Yes
No
 

Do you carry a separate daycare policy?

Yes
No
 
Do you run any other type of business out of your home?

Yes
No
 

Have you made any claims on your home insurance in the last 6 years?

Yes
No
 

Would you like a quote for life insurance to cover your mortgage, family or any other commitments you have?

Yes
No
 
You received additional discounts by having your home and auto insurance with Greylock Insurance.
Do you have any auto insurance policy you would like us to quote?

Yes
No
 

We need a few more things to accurately quote your home insurance with all of our carriers. Please upload a copy of your current home insurance policy and a few photos of your home so we can get started. For the photos, we need the outside only, and we need to be able to see all four sides. Please also include a picture of any other structures on the property.

Maximum of 4 files. Additional files can be emailed to GreylockInsuranceAgency@greylock.org

Would you like a quote for a personal umbrella excess liability policy?

Yes
No
 

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