Home Quote Request

Please provide the following information and we will contact you. Contact us for more information about Home Insurance from Concierge Risk Solutions. Our offices in New York serve homeowners with houses, condos and mobile homes nationwide with comprehensive Home Insurance policies.
Need help? We'll make it easy for you.
Call (516) 876-8300
E-mail info@conciergerisk.com

Name

First

Last

Address

Street Address

City

ZIP Code

State

If you own your home, how much insurance do you want quoted?

If you rent or own a condo, how much do you want on contents quoted?

Your Employer Name

Spouse's Employer Name

Your residence is

Owned Rented

Residence Type

House Condo Apartment Mobile Home Farm

If we have any questions, Phone

Best Time to Call

Underwriting Information Needed

Home Construction

Brick-Stone Frame

Estimated Year Home was Built

Distance From Home to Fire Hydrant

Is your home is over 30 years in age?

Yes No

The Information below is Prefilled - Only change where needed.

Wood burner in home?

Yes No

Is primary heat wood?

Yes No

Smoke detectors?

Yes No

Fire extinguisher in home?

Yes No

Central alarm system?

Yes No

Do you have a pool?

Yes No

Is the home outside of town?

Yes No

1. Is any business conducted at your home?

Yes No

2. Any full time residence employees?

Yes No

3. Any flooding, brush hazard, landslide hazard, etc?

Yes No

4. Any other residence owned, occupied or rented?

Yes No

5. Does any applicant own or are there any exotic pets or animals kept?

Yes No

6. Is your home on more than 5 acres?

Yes No

7. During the last 10 years, has any applicant been convicted of the crime of arson?

Yes No

8. Do you own, lease, or occasionally use any recreational vehicles?

Yes No

(Including boats, 4 wheelers, snowmobiles, jet skis, motor homes, motorcycles)

9. Do you have any special property that you want coverage on for breakage or loss?

Yes No

(Examples could include jewelry, fine arts, camera equipment, etc)

10. Have you had any claims on your home during the past 5 years?

Yes No

Questions, Comments, Preferred Agent

Please select the Submit button below. This form will be sent to Concierge Risk Solutions, 320 Post Ave. Suite 107 Westbury, New York, 11590, Phone: (516) 876-8300, Fax: 516-210-0125. We will send you a notification that your request has been received and will then prepare your quotation with several options. Your quotes will be returned via email.
Current quotes are being processed for states of New York.

39 Koenig Drive Oyster Bay NY 11771
zeenat.h@conciergerisk.com
Phone: (516) 946-2424
Fax: (516) 210-0125

Developed By Snergy Interface Ltd.

Home Quote Request

Underwriting Information Needed

The Information below is Prefilled - Only change where needed.

Concierge Risk Solutions

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