Wallace & Berry Associates, Inc. - An independent Insurance Agency representing the best insurance companies in the business; 'Travelers', 'Chubb', 'Hanover', 'Selective', and 'New York Central Mutual'.

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Name

Present Insurer

Address

Expiration Date

Location of Dwelling

Premiums

Day/Phone

Ext

Credit Score

Excellent
Good
Fair
Poor

Evening/Phone

Ext

Best Time to Call

Type of Dwelling

Home Condo

Construction

If Condo, Number of
Units in Building

Frame

Year Built

Brick/Stone

Style

Aluminum/Vinyl Siding

Square Footage

Coverage Amount

Number of Rooms

If there were losses, please explain:

This is not an offer to sell insurance or an advertisement of insurance in any place except the State of New York, United States of America. Wallace & Berry Associates, Inc. is a licensed Agent in the State of New York.