Thank you for requesting a quote from Ashmead Insurance.  Please fill in the information requested below and we will promptly respond with  your quote.

Personal Information
           
First Name:  
Last Name:  
Address 1:  
Address 2:  
City:  
State:  
ZIP Code:  
Email Address:  
Home Phone:  
Work Phone:  
   
Current Insurer Information
 
Company:  
Policy Expiration Date: Month Day Year

Address of Property to be Insured

Address 1:  
Address 2:  
City:  
State:   
ZIP Code:  
   
Plan Information
 

Tip - Have your current policy to refer to, it will help you to select comparable coverage amounts.
 

Amount of Dwelling Coverage:

  $

Amount of Liability Coverage:

 $

Deductible:

  $

Number of claims in last 5 years:

  

Township or Borough:

  

Feet from nearest fire hydrant:

  

Distance to nearest fire department:

  

Type of Construction:

  

Year Built:

  

If over 25 years old:

Roof age: 

  years

Furnace age:

   years

AMP Wiring age:

   years

Dog-Breed of dog:

 

Check all that apply:

   Smoke Detectors
    Dead Bolt Locks
    Wood Stove
    Pool
  Burgler/Fire Alarm

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Ashmead Insurance Associates Inc.| 2422 N. Broad Street, Colmar, Pennsylvania 18915
Phone: (215) 822-7573 | Fax: (215) 822 - 5172 | Email Us! | Disclaimer