Fairfield County CT Homeowners Insurance Quote

**Information received from this Connecticut Homeowners Insurance quote
request form sent to the William Malloy Insurance Agency will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be
based on the homeowners insurance policy information provided and does not
guarantee acceptance of the risk by us. The precise coverage afforded is subject
to meeting underwriting guidelines, and the terms, conditions and exclusions of
the policy as issued. By submitting this request you acknowledge that this is
neither an offer to insure nor a guarantee of insurance. Completion of this form
does not entitle you to a Connecticut Homeowners Insurance policy. We are
licensed in Connecticut and will not provide quotes for other states.

We are your local Fairfield County insurance agency, offering affordable
homeowners insurance policy services in the following Connecticut cities and
counties: Stamford, Norwalk, Greenwich, Darien, Riverside, Belltown,
Springdale, Round Hill, Old Greenwich, East Norwalk, New Canaan, Glenville,
Byram, Cos Cob, Mianus, North Stamford, Glenbrook, Wilton, Weston, Long
Ridge, Noroton, West Norwalk, Westport, High Ridge, Southport, North Wilton,
Winnipauk, Cannondale, Turn of River, South Wilton, Lyons Plains, Georgetown,
Ridgefield, Branchville, Redding, Topstone, Ridgebury, Redding Ridge,
Branchville, Dodgingtown, West Redding, Titicus, Hattertown, Bethel, Danbury,
New Fairfield, Newtown, Hawleyville, Botsford, Monroe, Bridgeport, Stepney,
Shelton, Huntington, Upper Stepney, Long Hill, Trumbull, Stratford, Easton,
Fairfield, Greenfield Hill, Stratfield, Nichols, Oronoque, Rivercliff, Devon, Lordship,
and East Bridgeport, New Haven, Hartford, Torrington, Waterbury, Meriden, New
Britain, New London, Norwich, Manchester, East Hartford, Suffield, Granby,
West Haven, West Hartford, Branford, East Haven, Hamden, Woodbridge,
Orange, North Haven, Groton, Rocky Hill, Newington, Wethersfield, Glastonbury,
Bloomfield, Blue Hills, South Windsor, Naugatuck, New Hartford, Chesire, East
Lyme, Old Mystic, Wallingford, Southington, Middletown, Bristol, Laurel Beach,
Litchfield, Pleasure Beach, Mystic, North Westchester, Double Beach,
Willimantic, Storrs, Canaan, East Windsor, Vernon, South Canaan, Putnam,
Guilford, Windham, South Britain, Willington, Windsor, East Hampton, Brooklyn,
Westchester, and everywhere else in New Haven County, Litchfield County,
Middlesex County, New London County, Hartford County, Tolland County and
Windham County, CT.

In addition to Connecticut
Homeowners Insurance, we
also offer affordable Car
Insurance policy premiums
or choose another CT
family insurance coverage
from the list below.

Connecticut Homeowners Insurance Coverages & Limits of Liability

Full Name:
Address to be Insured:
City:     State:     Zip Code:
Email Address: (Required)
Home Phone: Work Phone: Ext.
How to Contact You:
Date of Birth:             (mm/dd/yyyy)
Social Security Number:

Do you currently have homeowners insurance?
Current Premium:$ per month
Coverage requested for?
Usage Type:
Years Lived at Address to be Insured:

Dwelling ($ value):
Additional Structures ($ value):
Personal Property ($ value):

Personal Liability (each occurence):
Medical Payments (each person):
Deductible:

Replacement Cost, Dwelling: Yes No
Replacement Cost, Contents: Yes No

Building Structure:
Year Dwelling Built:     Dwelling Square Feet:
Primary Heat Type:
Fireplace:
Full Baths:     Half Baths:
Garage:         Garage Size:
Basement:

Wiring Renovation:         Wiring Renovation Year:
Plumbing Renovation:     Plumbing Renovation Year:
Heating Renovation:       Heating Renovation Year:
Roofing Renovation:       Roofing Renovation Year:
Roof Type:     Roof Age (years):
Exterior Paint Renovation:     Exterior Paint Renovation Year:

Dwelling Location:     Dwelling Occupied By:
Swimming Pool:              Diving Board:
Approved Fence:

Did you have any losses, whether or not paid by insurance, during
the last 3 years, at this dwelling location or any other location?
If the answer to the previous question was "Yes", please explain below.

Date                            Type                            Description of Loss                    Amount of Loss



Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your Connecticut Homeowners Insurance quote request.**

Applicant Information

Policy Endorsements

Connecticut Homeowners Insurance - Dwelling Information

Loss History