new york homeowners insurance from ProActive Brokerage of Babylon, NY

 


On-Line Vacant Land
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
State (Must be New York):
Zip/Postal:
E-Mail (REQUIRED):
E-Mail (again for accuracy):
Phone:
Fax (optional):
 
Dwelling Information
 
Full Address of Vacant Land:
Total Acreage:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:

Describe Any Structures on Land:
 
Coverages:
 
Liability Limit Requested $
 
Comments/Remarks
(describe any other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone

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