Home Insurance need not be complex and we make it simple for you!
• Dwelling coverages
• Replacement Cost
• Coverages for structure
• Loss of use
• Medical expenses
• Liability exposure
• Additional coverages for jewelry, electronic devices, etc.

Contact Information

Name:
Address:
City, State, Zip:
E-mail:
Home Phone:	Ex 1.555.555.5555
Work Phone:	Ex 1.555.555.5555
Fax:	Ex 1.555.555.5555

Property Information

Property Type:
Year Built:
Construction Type:	Frame Brick
Home Address:
City:
State, Zip:
Home Inside City Limits:	Yes No
Any wood burning stoves, other than fireplace:	Yes No

Protective Devices Present

Deadbolt Locks:	Yes No
Smoke Alarms:	Yes No
Fire Extinguisher:	Yes No
Local Burglar Alarm:	Yes No
Central Station Burglar Alarm:	Yes No
Central Station Fire Alarm:	Yes No

Prior Losses

Any losses in the past 5 years?	Yes No
If Yes, please explain:

Present Insurance Company

Insurance Company:
Policy Expiration Date:	mm/dd/yy

Coverage Amounts

Dwelling:
Liability:
Personal Property:
Deductible:	$250 $500 $1000

Occupant 1

Occupant 2

Name:
Date of Birth:	mm/dd/yy	mm/dd/yy

You cannot afford to be without home insurance. Especially in the Long Island home insurance area, how do you know how much home insurnace you need, and what are your options for flood insurnace, contents insurnace, what is your rebuild value! These are the questions that we can answer at Completely Covered Insurance, your long island home insurance specialists. We are a family company with the clout of a huge concern, having lasting relationships with the best home insurance providers in the country. We don't pressure you, we simply show you what we can do for your home and family and let the bottom line be your guide.

Completely Covered Insurance Company : Long Island, New York : Commercial Insurance, Auto Insurance, Automobile Insurance, Car Insurance, Home Insurance, Marine Insurance, Boat Insurance, Long Island Cheap Insurance

DESIGNED & MAINTAINED BY THE CYBERNET PLACE :

Home Insurance need not be complex and we make it simple for you! • Dwelling coverages • Replacement Cost • Coverages for structure • Loss of use • Medical expenses • Liability exposure • Additional coverages for jewelry, electronic devices, etc.

Home Insurance need not be complex and we make it simple for you!
• Dwelling coverages
• Replacement Cost
• Coverages for structure
• Loss of use
• Medical expenses
• Liability exposure
• Additional coverages for jewelry, electronic devices, etc.