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Contact Name *
Current Insurance Information
Current Annual Premium
Amount of Liability
Earthquake Coverage Desired?
Have you filed for bankruptcy within the past 7 years?
Estimated Replacement Cost
How Many Floors?
Type of Construction
(check all that apply)
Central Station Fire Alarm
Central Station Burglar Alarm
Home Located within 5 miles of Fire Station
Home Located within 1000 feet of a Fire Hydrant
Home located within City Limits
List any claims in past 3 years:
Estimated value of your personal property:
Jewelry & Watches
Stamp and Coin Collections
Fine Arts and Breakable Items
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- The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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4112 N. Croatan Highway Kitty Hawk NC. 27949