Dooley Dereemer Orr Agency Inc. - Home, Auto, Life and Business Insurance in New York

Give me a quote for an apartment

Submitting information from this web-site does not bind coverage or acknowledge receipt. You must receive a written or e-mailed confirmation from us to acknowledge or bind coverage.

What is your name and address:

Name
Email
Address
Address
City	State Zip

What will the effective date be:

How much coverage do you need for your belongings?

Do you need coverage for improvements and betterments
(permanent parts of the apartment, which you have added)
No Yes
How much coverage would you like?

What is the construction of your apartment building?
Frame Brick/Stone

How many units are in your apartment building?
1-4 More than 4

How far do you live from tidal water?
Less than 1000'
More than 1000'
More than 1/2 mile
More than 1 mile

What deductible would you like?
250
500
1000
2500

How much liability coverage would you like?
100,000
300,000
500,000

Do you have any home safety devices?
Central Station Fire Alarm
Central Station Burglar Alarm
Non-Smoker
Dead Bolt Lock on all exterior doors
Smoke Detectors

Would you like Off-Premises Theft Coverage?
(Coverage for your personal items if they are stolen while away from the premises, subject to your deductible)
Yes No (reduces premium)

Do you have any personal items you would like to schedule?
(specifically list to cover)
No Yes

Item Amount Replacement
Value Actual Cash
Value

Jewelry (watches)

Furs

Cameras

Silver

Fine Arts

Other

How far is the nearest fire hydrant?
within 1000' over 1000'

How far is the nearest fire station?
within 5 miles over 5 miles

Are you retired?
No
Yes Please give your date of Birth

How would you like us to give you your quote?

Please e-mail me, my address is

Please call me, my phone # is

Please mail it to my address above

Please mail it to another address