Bouvier Beckwith & Lennox, Inc.
West Hartford, CT
P 860.232.4491
Toll free 800.547.2000 in state

Root Insurance Agency
East Haddam, CT
P 860.873.8606

Champion Insurance
Old Lyme, CT
P 860.434.1611

Clarke Insurance Agency
Manchester, CT
P 860.643.1126

Genovesi Agency
Manchester, CT
P 860.643.2131

Mathieu Insurance
Norwich, CT
P 860.887.1617

Scholes Insurance
East Haddam, CT
P 860.767.8219
Toll free 800.305.4432 in state

Home Insurance Quote Request

Use this form to request a home insurance quote, and we will contact you promptly.

Check here to allow us to run an insurance score.
This allows us to determine the best pricing tier for you

Your Information

Name*

Telephone*

Email Address

Mailing Address*

City*

State*

Zip Code*

Mailing Address*

City*

State*

Zip Code*

Check here if you've had bankruptcy, tax lien, sustained any judgment, foreclosure, or repossession.
Will you live in the house? Yes No
Will this be escrowed? Yes No
If new purchase:
	Price:
	Mortgage Amount:
	Closing Date:
Are you insured by us? Yes No If no, referred by?
Construction Type: Frame Brick Any Stucco
Other
Style of Home:
Year Built:
No. of Stories:
Total Sq Ft:
If/when were the following updated over the last ten years?
	Plumbing:
	Electrical:
	Heating/Furnace:
	Roof:
	Flat Roof:

Other

Baths

Any Other Special Features?

Clarke Insurance Agency
Manchester, CT 06040
P 860.643.1126