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About Our Homeowners Program
PA online home insurance information and quotes
What Sets OUR Homeowners Products Apart from the rest?

low rates on PA home owners insurance plans  ° Save over 20% with home & auto discount!

 ° We write older homes!

 ° Homes 50 yrs and newer eligible for up to 40% off!

 ° Water and Sewage backup coverage available.

 ° Low rates and Same-Day policy issue!

Get your FREE Pennsylvania Homeowners Quote NOW!

 
On-Line Boat & Jet Ski
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Street Address:
City:
State: (Must be Pennsylvania)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Boat Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Is this Boat Co-owned?
(If yes, list all owners names)


OPERATOR INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:


OPERATOR INFORMATION #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:


VESSEL & UNDERWRITING INFORMATION
Year of Boat: Make & Model
(be specific):
 
Boat Length: Hull Type
(wood, Metal,
fiberglass, etc):
 
Max. Speed
(in MPH):
Market Value: $
 
Engine Make: Engine Type:
(Inboard, I/O, Jet)
 
Engine Horse
Power:
Fuel Type:
(Gas, Diesel, etc.)
 
Trailer Cov.
Needed?
Yes No Yr./Make/Model
of Trailer:
 
Trailer Value: $ Where is boat
moored or stored?
 
Describe waters
boat taken on?
Describe boat
general usage?
(fishing, ski, etc.)


VESSEL COVERAGES:
Limits of
Liability:
$15/30 BI / 10 PD $25/50 BI / 15 PD
$50/100 BI / 25 PD $100/300 BI / 50 PD
$250/500 BI / 100 PD
 
Hull Coverage: NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Water Ski
Medical Coverage?
Yes No   Uninsured
  Motorists Cov.?
Yes No
 
Comments or Remarks:
(List additional drivers,
special coverages, etc. here)


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Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Questions? E-Mail Us At: quotes@pa-homeinsurance.com | Our Pennsylvania Insurance License #: 365642
Buhl Insurance Agency Inc. . 4204 East Ewalt Road . Gibsonia, PA 15044 . Phone: 724-443-5610 . Fax: 724-443-5622

PA-Home Insurance.com has made purchasing Pennsylvania homeowners insurance EASY. We have developed a website where anyone can find, compare, and purchase Pennsylvania home insurance online. We provide you access to the nations leading insurance carrier to find you the best value on PA home insurance and other homeowners insurance products. Letting us shop for you allows you to save money on your Pennsylvania homeowners insurance through a top Pennsylvania insurance carrier. Get a free quote on your Pennsylvania home insurance today. Keywords used by customers to find us online include: Pennsylvania homeowners insurance, PA homeowners insurance, low cost Pennsylvania home insurance, PA homeowners insurance policies for Pennsylvania, pennsylvania home insurance quotes.

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