Personal coverage

 

 

 

Home Owners / Flood Insurance Quote Form

This form is to request a quote from our Experienced Professionals and does not generate automatic quotes.  You will be contacted shortly by one of our representatives so that we may work with you to find the best coverage for your needs. For an accurate estimate, please fill out All fields. Fields in Red are required. This is a secure form for your protection.
If you prefer to talk to a representative, please call (800)222-0131.

The Van Dyk Group is licensed in the following states: NJ, NY, PA, MD, NC, SC, VA, FL, & DE
Select Type of Quote Desired : Home Owners Flood Both
Name:
Property Address to Insure:
Street Address
City State Zip
Mailing Address
E-mail Address
Occupation
Date of Birth
SS#
Year Built
Phone #
Total Square Footage
# of Baths
   
# of Stories excluding Basement        
Marital Status :    Married    Single     Divorced    Widowed
Date Purchased if Own    
Purchase Price
Mortgage Amount
Date of Closing
# of Families
In Home Business? Yes No
Condition of Home
How will Home be Occupied? Owner Tenant
Do you have dogs?Yes No -- List # and Breed
Distance to Sea Coast
Were There any claims in the Past 5 Years? Yes No
Utilities - List Year last Updated
Roof
Plumbing
Heat
 Wiring
Construction Information
Frame or Masonry?
Heat Type
Type of Foundation
Foundation Vents? Yes No
Is area enclosed below house? Yes No
Is there Machinery/Equipment below house? Yes No
Other Amenities - Select All that apply.
Underground Tanks Flat Roof
Swimming Pool Fireplace
Decks Porch
Central Air Garage
Alarm system Fenced