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Fast Insurance Quotes by Phone or On-line from our New York Insurance Center.
Time Saving Cost Comparisons & Quality Service... Call Us Today!

 
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Low Cost
Insurance

High Quality
Service!


Call Us for a
RUSH Quote.
We can place
Coverage
INSTANTLY!

 
Or, Get A FREE
Quote On-Line

 
 
   Automobile Insurance
   "D.W.I." Auto Insurance
   Homeowners Insurance
   Mobilehome Insurance
   Renters Insurance
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   Motorcycle & ATV
   Boat & Jetski Insurance
   Snowmobile Insurance
   Motorhome/Travel Trailer
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   Commercial Auto Insurance
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Service Your Account

 
Contact Us
 
 
E-Mail:
john@joinsurance.com

Phone:
Toll Free:
866-353-8817
Direct Line:
716-823-1801

Facsimile:
716-823-2483

Mailing Address:
John Obstarczyk
Insurance Agency
16 Lake Ave.
Blasdell
NY 14219

More About
Our Agency!


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Our carriers offer 10% off your Home and Auto Insurance when we write both policies.

"Remember,
All Our Policies
Come with an Agent!"

We Are Proud Members of the Better Business Bureau!

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Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
Your "County" is?
State: (Must be New York)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
Birthdate of Primary Prospective Insured: (some carriers require to quote)
 
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Is this Builder's Risk?
(new home constr.)
NO YES
 
Month/Year home
to be complete:
 
Number of units: 1 family Duplex
3 Units 4 Units
 
Type foundation: Slab
Crawlspace over slab
Poured Walls
Cement/Concrete Block
Other (list in remarks)
 
Type Construction: Frame
Brick/Veneer
Stone
Other (list in remarks)
 
Type Roof: Shingle
Wood Shake
Tar/Gravel
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Trampoline on Premesis? Yes No
 
Swimming Pool on Premesis? Yes No
 
If yes, what kind of pool? above ground
in ground
 
Is pool fenced? fenced
un-fenced
 
Is garage attached or detached? Attached or Built-in
Detached
 
How many cars can garage accomodate? 1 1.5 2
2.5 3
 
Name of Fire Department?
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Rate Your Credit History and Past Insurance Payment History:
(Some companies products are
based on your credit and payment history.)
Excellent Fair
Poor Horrible
 
Heat type: Forced Air
Electric
Gas/other
 
Plumbing type: Copper
Galvanized
Mixed (Copper/Galvanized)
 
Circuit Breakers or fuses? Breakers Fuses
 
If Home over 25 years
of age, please list year
of updates of systems:
Roof:
Electrical:
Plumbing:

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning,
alarm systems, porch, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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