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Homeowners Insurance Quote Form (New York State Only)
Please complete the following form and click the "Send To Tuke Agency" button to submit for a FREE homeowners insurance quote. The Tuke Agency serves Upstate and Western New York. Final premium is subject to verification of information and inspection. All information provided will be held in strictest confidence and used only for the purpose of providing an accurate rate for this specific policy.
Name:
Street Address :
City:
State:
Zip:
Phone Number:
E-Mail Address:
Applicant Date of Birth:
Your present insurer:
Construction Type:
Age of Home:
Do You Have Smoke Detectors?: Yes No
Do You Have Fire Extinguishers?: Yes No
Do You Have A Central Station Alarm?: Yes No
Do You Request Flood Insurance?: Yes No
Amount Of Insurance Requested
Dwelling:
Contents:
Liability:
Deductible Requested:
Please enter any questions or comments below. If you have any items to be scheduled such as jewelry, paintings, silverware, computer equipment etc., please enter item description and value.