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Community Association Unit Owners (HO-6) Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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E-Mail Address
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Primary Phone Number
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Date of Birth
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/ /
Social Security Number
Optional
Community Association Name
Required
Occupancy
Required
Date of Original Purchase
Optional
/ /
Dogs
Required
Current Information
Do you currently have insurance?
Optional
Current Premium
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Current Insurance Provider
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Months With Company
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Current Policy End Date
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/ /
Claims/Property Losses in Past 5 Years (Please Explain)
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Underwriting Information
Does Gerelli Insurance service the Master Policy for the complex? If Yes, Skip Undewriting Info and complete Coverage Requested.
Optional
Year Built
Optional
Roof Type
Optional
Construction Type
Optional
Square Footage of Unit
Optional
Fire Hydrant within 1000 feet
Optional
Coverage Requested
Dwelling - Additions and Alterations Limit
Optional
Personal Property Limit
Optional
Deductible Amount
Optional
Loss Assessment Limit
Optional
Water Backup Coverage
Optional
Liability Limit
Optional
Scheduled Personal Property Limit (Jewlery, Furs, Etc)
Optional
Additional Information
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How did you hear about us?
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Submission Validation
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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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