Park Insurance Associates, Inc. - NJ Homeowners Insurance Quotes

We offer special coverage for your home and additional discounts on new homes and policy discounts for home and auto.

Fill out our quote request form below and a Park Insurance Associates agent will
contact you soon. Please fill all applicable fields. Please read our privacy statement before
submitting.

Name

Address

City, State, Zip

Type of Heating

oil gas other

If oil heat, where is the oil tank located

If home has an oil tank, is it located above or below the ground?

above below

Are you located within 500 ft. of any bodies of water?

yes no

Purchase price of home

Balance on Mortgage

Home phone number

Work phone number

Age of home (years)

Is your home brick or frame?

brick frame

Any claims in the past 3 years?
If yes, explain in full

yes no

What is the distance between your home and the next structure to your left, right , and behind you.

	to the left
	to the right
	behind you

Any dogs? If Yes, explain number
breed(s), and age(s)

yes no

If any dogs, please list predominant breed and age

Any swimming pools? If yes,
how is it protected

yes no

Any trampolines on the premises

yes no

Does anyone conduct a business from the insured premises? If yes, please explain

yes no

Does the dwelling have a flat or pitched roof?

pitched flat not sure

Did you have any lapse in coverage?
If yes, how long?

yes no

Has any company cancelled you in the past 3 years? If yes, explain.

yes no

Date Insurance is needed?

Disclaimer: Park Insurance will never share nonpublic personal information to non-affiliated third parties for purposes other than those that are permitted by law.