Homeowners & Renters Insurance
Quote Request Form
Pennsylvania

To receive a quote, please fill out the form below....

Insured 1:
     Date of Birth:       Social Security #:  (Optional)
Insured 2:
     Date of Birth:       Social Security #:  (Optional)
Address:
City, St., Zip:
Home Phone Number:
   Cell Phone:
E-Mail Address:
Location
(if than the address above):
You are a: 
This is a 
Current Insurance Information
Insurance Company: 
Expiration Date: 
Your Current Coverages
Dwelling Amount Other Structures Contents/Personal Property Liability Limit Medical Payments Other Optional Coverages
$ 
$ 
$ 
Identity Theft
Dwelling Under Construction Coverage
Mine Subsidence
Motorized Golf Cart
In home Office, Private School or Studio in your home
Sinkhole Collapse Coverage
$ Student Living away from Home
Water Craft Liability
  • Only private pleasure or recreational use is eligible
  • Power boats over 26 feet and jet-skis are not eligible.
  • Maximum speed 50 miles per hour.

    		•
    $ Watercraft Hull Coverage
    $  Water Backup
    Any property that should be schedule, due to its value....
    Jewelry
    		 Furs
    		 Silver, Gold & Pewterware
    		 Firearms
    		 Camera & Equipment
    Fine Arts
    		 Amateur Musical Instruments
    		 Stamp Collection
    		 Coin Collection
    		 China & Crystal
    Type of Dwelling: Property Deductible Year Built Construction Other Information
    Square Footage:    Type of Home: 

    # of Stories: 
    Updates to Home:
    Furnace
    Year: 
    Plumbing
    Year: 
    Roof
    Year: 
    Electrical

    Wire Type:       Fuse Type: 

    Year: 

    Any other coverages, comments and any additional information....

    PROTECTION (Check all that apply).....
    Smoke Detectors? 
    Fire Extinguishers: 
    Burglar/Fire Alarm: 
    connected to central station
    Dead Bolts: 
    Sprinkler System: 

    GENERAL QUESTIONS

    Do you have a wood burner stove?
    Yes
    No
         If YES, was it professionally installed?
    Yes
    No
    Do you operate a business from your home?
    If YES, Type of Business:
    Yes
    No
    Have you ever filed for bankruptcy?
    Yes
    No
    Do you have a trampoline?
    Yes
    No

    CLAIMS INFORMATION...
    DATE WHAT HAPPENED AMOUNT PAID

    M c G R A T H   I N S U R A N C E   G R O U P

    4170 William Penn Highway, Murrysville, PA. 15668-1890
    (724) 327-8474                  (FAX) 327-7911
    Toll Free: 1-800-977-2999               (FAX) 1-888-800-0034