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Community Association Quote Form


Please complete the following survey for a free, no obligation quotaiton. The following is a list of the standard information needed to obtain quotation from any one of the insurance companies we represent:  Offering Plan inclding the Association By-Laws, Financial Statement, Site Plan and Loss Runs .

Community Association Name
Required
Type of Association
Required
Location Address
Required
City
Required
State
Required
ZIP / Postal Code
Required
Association Website Address
Optional
Do you use a Management Company?
Optional
Name of Management Company
Optional
Underwriting Information
Number of Units
Optional
Number of Buildings
Optional
Year Built
Optional
Personal Information
First Name
Required
Last Name
Required
Connection to Association
Optional
Primary Phone Number
Required
E-Mail Address
Required
Additional Information
Prior Insurance
Optional
Expiration Date
Optional
/ /
Any claims in past 5 years?
Optional

Description of Claims (if applicable)
Optional
How did you hear about us?
Optional
Coverages Requested
Optional


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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
Gerelli Insurance Agency, Inc.   |   PO Box 362, Cold Spring, NY 10516   |   (845) 265-2220   |  Fax: (845) 265-4754               Powered by Insurance Website Builder 

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