Maine Home Insurance Policy Quotes

Full Name:
Mailing Address:
Address to be Insured:
City:     State: MAINE    Zip Code:
Email Address: (Required)
Home Phone: Work Phone: Ext.
How to Contact You:
Date of Birth:             (mm/dd/yyyy)
Social Security Number:
Do you have current Homeowners Insurance coverage?
If yes, include name of insurance company:

Coverage requested for?
Usage Type:
Years Lived at Address to be Insured:

Maine Homeowners Insurance Coverages & Limits of Liability

Dwelling ($ value):
Additional Structures ($ value):
Personal Property ($ value):

Personal Liability (each occurence):
Medical Payments (each person):
Deductible:

Policy Endorsements

Replacement Cost, Dwelling: Yes No
Replacement Cost, Contents: Yes No

Maine Homeowners Insurance - Dwelling Information

Building Structure:
Year Dwelling Built:     Dwelling Square Feet:
Primary Heat Type:
Do you have a Wood Stove? If yes, is it on a separate flue?

Fireplace:
Full Baths:     Half Baths:
Garage:         Garage Size:
Basement:

Wiring Renovation:         Wiring Renovation Year:
Plumbing Renovation:     Plumbing Renovation Year:
Heating Renovation:       Heating Renovation Year:
Roofing Renovation:       Roofing Renovation Year:
Roof Type:     Roof Age (years):
Exterior Paint Renovation:     Exterior Paint Renovation Year:

Dwelling Distance from Fire Department: miles    REQUIRED
Dwelling Occupied By:
Swimming Pool:              Diving Board:
Approved Fence:

Do you own any dog or exotic pet?
If YES, please list breed(s) and age(s):
Any agressive behavior or a bite history?

Loss History

Have you had any homeowners losses in the last 5 years?
If the answer to the previous question was "Yes", please explain below.

Date                      Type                  Description of Loss                Amount of Loss


Additional Information or Comments

**Information received from this Maine Homeowners Insurance quote request form sent to
Kieffer Insurance will be for our use only and will not be sold, given to or distributed to any
other parties. A quote will be based on the maine homeowners insurance policy information
provided and does not guarantee acceptance of the risk by us. The precise coverage
afforded is subject to meeting underwriting guidelines, and the terms, conditions and
exclusions of the policy as issued. By submitting this request you acknowledge that this
is neither an offer to insure nor a guarantee of insurance. Completion of this form does not
entitle you to a Maine Homeowners Insurance policy. We are licensed in Maine and will not
provide quotes for other states.

Please be advised that our insurance carriers may obtain an insurance score which
will enable us to provide you with an accurate quote. If you agree to these conditions,
please continue by submitting the quote request.

Click on the "Submit Quote Information" button below to
send your Maine Homeowners insurance quote request.**

We are your local Aroostook County, Maine full-service insurance agency,
offering affordable Maine Homeowners Insurance policy premiums to
residents of the following towns and counties: Caribou, Presque Isle, Van
Buren, Houlton, Perham, Washburn, Crouseville, Mapleton, Fort Fairfield,
Ashland, New Sweden, Portage, Limestone, Mars Hill, Bridgewater,
Easton, Blaine, Guerette, Keegan, St. Agatha, Grand Isle, Fort Kent,
Madawaska, St. John, St. Francis, Dickey, Clayton Lake, Allagash,
Winterville, Knowles Corner, Smyrna Mills, Littleton, Ludlow, Millinocket,
Bangor, Waterville, Pittsfield, Augusta, Auburn, Lewiston, Bar Harbor,
Ellsworth, Belfast, Bucksport, Bath, Portland, Saco, Biddeford, Penobscot
County, Piscataquis County, Somerset County, Washington County, and
Cumberland County, ME.