Curley Insurance Agency, Inc

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996 Main Street
Millis, MA 02054
Business: (508) 376-4377
Toll Free: (800) 513-4377
Fax: 508-376-2538
Email: william.t.curley@verizon.net


ONLINE PROPERTY QUOTE FORM

Your Full Name:

E-mail Address:

Phone Number:

 Best time to call:

Date of Birth:

 

PROPERTY INFORMATION

Street Address:

Address Two:

City: 

State: 

Zip Code: 

New Purchase:

Closing or Expiration Date: 

Liability Limit:

Amount of Insurance: 

Deductible:

Number of Families: 

Free Standing:

Construction: 

Smoke Detectors:

Wood Burning Stove: 

Smoker: 

Swimming Pool: 

Mortgage Amount:

 

 

Purchase Price:

 

 

 

PET INFORMATION

Dogs:

Age:

Breed:

Years owned:

 

INSURANCE INFORMATION

Any Liability or Property Losses: 

 

Could You Please Give Us Details:
 

 

Previous Carrier: 

 

Previous. Amount of Insurance:

 

Approximate Year House Built: 

 

Electricity Updated

 

Plumbing Updated

 

Heat Updated

 

Roof:      Age of Roof:

 

Lead Paint Inspection Certificate: 

 

 

OPTIONAL COVERAGES
Check off the coverages you would like!

 

Replacement Cost On Contents

 

 

Scheduled: Jewelry/Furs/Fine Arts

 

 

If you have any comments or questions please state them below:


     

 

 

 

 


Building Curley Insurance Agency, Inc. – Offering auto insurance, home insurance, business insurance, and life insurance in the areas of Millis, Medfield, Sherborn, Holliston, Medway, Norfolk, Wrentham, and Franklin, Massachusetts. Representing the Commerce, Plymouth Rock Assurance, Bunker Hill, and Merchants Insurance Group.

 

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