The Frigault Agency, Inc. Protecting all the things you love. Auto, Home, Life, Business, Boat.
 (315) 797-8080
136 Clinton Road (Rt 12b), New Hartford, NY, 13413
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Homeowner Insurance Quote Request

 Note:  Questions marked in red are required items and must be answered 
prior to clicking submit.

Referrer's Name:
Name: Phone:
Mailing Address: E-Mail:
Property Location: DOB
City/Town: , NY  Zip: County:

       Current Coverage's

Dwelling: Liability:
Other Structures: Medical Payments:
Personal Property:
Loss of Use:
Deductible Desired:
Year Constructed:
Number of Family:
Construction Type:

Please answer the following questons:
(Explain all "Yes" answers in the remarks section below)

1. Any other structures (garage, storage building, residence etc.) on premises? Yes No
 2. Any insurance declined/canceled or non-renewed in the last three years? Yes No
3. Are there any other type of heating devices used other than central? Yes No
4. Do you have any other insurance with this company? Yes No
5. Swimming pool on premises? Yes No
Fenced In Ground Above Ground
6. Any animals on premises?   Yes No
Number and Breed:
7. WiringYear of last update?  Circuit Breakers:Fuses:
8. Plumbing: Year of last update? Copper Pipe: PVC:
9. Roof: Year of last update? Shingle: Rubber: Metal:
                                               Rolled Roof (Tarpaper):
10. Heating: Year of last update?   
Cleaned/maintained at least once per year?


11. Any claims in the last five (5) years? Yes No
12. Who is the responding Fire Department 
13. Is the home a townhouse? Yes No
14. Are there any smoke alarms in the home? Yes No
15. Do you own any recreational vehicles, such as a snowmobile or a boat?


Please ensure that all questions marked in red have been answered prior to clicking submit.


We help you find the right solution by understanding your needs. Give us a call(315) 797-8080
136 Clinton Road (Rt 12b), New Hartford, NY, 13413