The Paul F. Tilly Agency, LLC.
1891-1897  Rochester St , P.O Box 37A,  Lima, NY  14485  
Phone: (585) 582-1660               Fax: (585)582-1018               
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The following companies offer 24/7 services online:   
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Homeowners Insurance Quote Request

This application process will allow you to request a quote for homeowner's insurance.

This is some information you should have available to complete the application:
   
   1)  Zip Code of the insured home
   2)  Value of the home
   3)  The year that the home was built  

All required fields are marked with an *

Name: *
Additional Names On Deed:
Phone Number: *
Mailing Address *
Physical Address of Dwelling (If Different):
E-mail Address: *
Your Date Of Birth: *
Do You Currently Have Home Insurance? * No Yes Newly Purchased Home
If You Currently Have Insurance, How Much Is It Insured For? Or, If This Is A New Purchase, How Much Did You Purchase It For?
Have You Had Insurance Denied or Cancelled In The Last 3 Years? * No Yes
What Year Was The Home Built? *
In What Year Did You Purchase It? *
Is This A Seasonal Dwelling? * No Yes
Is This A Multi-Family Home? (Please Note That For A Homeowner Policy, It Must Be Owner-Occupied.) *
Is This A Frame Or Masonary Building? *
How Many Square Feet of Living Space? *
How Many Stories Is House? *
How Many Bedrooms? *
How Many Full Bathrooms? *
How Many 1/2 Bathrooms? *
How Many Kitchens? *
Is This House More Than 30 Years Old?(If No, Please Skip To Next Section) * No Yes
Has The Roof Been Replaced? No Yes
If Yes, What Year?
Has The Furnace Been Replaced? No Yes
When Was The Furnace Last Replaced or Serviced?
Are There Curcuit Breakers? No Yes
If No, Please Explain:
What Kind Of Plumbing In House?
What Type Of Siding Is On House? *
What Type Of Shingles On Roof? *
Is There A Basement? * No Yes
If Yes, Is It Full or Partial?
If There Is A Basement, Is It Finished? No Yes Some Of It
What Percent Is Finished?
Does The Basement Have A Walkout? No Yes
What Type Of Furnace Fuel Is Used? *
If You Have A Tank For Fuel, Is It Underground? No Yes
Are There Any Woodstoves or Fireplaces? *
Do You Have Central Air Or Air-Conditioning? *
Do You Have Any Decks or Porches? * No Yes
If Yes, How Many, What Size(s), And What Are They Made Of?
Is There An Attached Garage? * No Yes
If Yes, How Many Bay And What Size:
Are There Any Outbuildings (Sheds, Unattached Garages, Barns, etc)? * No Yes
If Yes, How Many, What Size, And What Is It Used For?
Do You Feel Your House Is: *
If Certain Parts Are Custom, Please List:
Do You Have Any Farm Animals? * No Yes
If Yes, Please List Types and Quanities:
Do You Have Any Exotic Animals? * No Yes
If Yes, Please List Types and Quantities:
Do You Have Any Dogs? * No Yes
If Yes, Please List Breeds:
Are All Dogs On Premises Licensed? No Yes
Do Your Dogs Have Any History Of Biting? No Yes
If Yes, Please Explain:
How Are The Dogs Restrained?
Are There Any Swimming Pools On The Premises? *
Is There A Fence Around The Pool? No Yes
How Many Feet Deep Is The Pool?
Are There Any Trampolines? * No Yes
Is Any Business Conducted On Premises (Including Child Care)? * No Yes
If Yes, Please Explain:
Do You Have A Generator? *
Are There Working Smoke Alarms In The House? * No Yes
Do You Have A Home Security System? * No Yes
Who Is The Responding Fire Department? *
Is The House Within 1,000 Feet Of A Fire Hydrant? * No Yes
Is The House Within 5 Miles Of A Fire Department? * No Yes
Do You Have Town Water or a Well? * Town Water Well
Do You Have A Submergible Pump (Sump pump)? * Yes No
Many Companies Offer Discounts If You Have Multiple Policies With Them. If You Have Any Other Insurance With Any Companies, Please Enter The Company And Type Of Policy Here:
Some Of Our Companies Use Credit-Based Insurance Scoring, So Please Either Enter Your Social Security Number, Or Call Us With It, So That We May Provide You With An Accurate Quote.
Please Enter Any Additional Information That You Think May Be Important, So That We May Get You An Accurate Quote:
Verification:
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