Toll Free: 800-967-3535 or 215-355-5996

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SafeGuard Insurance Agency, Inc. - 201 Bustleton Pike - Feasterville, Pennsylvania 19053
Phone: (215) 355-5996 - Fax: (215) 355-4598 - E-mail: safeguard@safeguard-insurance.com | Hours of Operation: Monday - Thursday: 9:00am - 7:00pm & Friday 'til 5:00pm

© SafeGuard Insurance Agency, Inc.  All rights reserved

Home Owners Insurance Quote Request Form

Fill out the form below and click "Submit" to receive your quote.

Personal Information

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.

First Name
MI
Last Name
Your Birth Date
Home Phone
Work Phone
Cell Phone
E-Mail Address
Last Name
MI
First Name
Address Line 1
Address Line 2
Zip Code
State
City
City
State
Zip Code
Address Line 2
Address Line 1
Current Premium
Deductible
Dwelling Amount
Policy Expiration Date
Current Insurance Carrier (Not Agency)
How long at present address?
Numbers of claims in the last 3 years
Year home was built
Square footage of home (excluding basement and garage)
Occupied by Applicant?
Within 1000' of Hydrant
Miles to Fire Station
If new homeowner, settlement date:
Address Line 1
Address Line 2
Zip Code
State
City
Age of roof
Number of Hearths
Number of Chimneys
Number of Fireplaces
Patio Sq. Ft.
Porch Sq. Ft.
Deck Sq. Ft.
Basement
# of Half Baths
# of Full Baths
Garage
Foundation
Construction
Type
Age of Heater
Location of Oil Tank
Fire Alarm
Covered Patio/Deck
Uncov. Patio/Deck
Central Air
Smoke Detectors
Dead Bolts
If yes, what breed?
Dog
Height of fence
Slide/Diving Board
If yes,
Pool
Trampoline
Woodstove
Heating System
Amps
Electrical System
Losses in the last 7 years?
Bankruptcy in the last 7 years?

Please give any additional comments or requests about the coverage you desire:

If yes, please explain:
Is your home a new purchase?
Is your home currently insured?
Type of Roof

Bankruptcy / Losses

Year Built
Burglar Alarm

Addresses

Spouse Information
Address of residence to be quoted (if different)

Current Policy Information

Home Information

Previous Address (if less than 2 years)

Structure Information
Features

Additional Features

Save money by quoting your home and auto together.  Click here to request an Auto Insurance Quote after you have pressed submit.

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