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Request a quote Call 609-345-2203

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Request a quote

Answer a few questions, about five minutes. An agent reviews them and contacts you with options.

What would you like a quote for?

Choose everything that applies.

We don’t write personal auto, renters, life, health, or pet insurance. For anything else, call us at 609-345-2203 and we’ll tell you whether we can help.

How can we reach you?

An agent will contact you to go over the details. Give us a phone number, an email, or both.

With the area code, for example (609) 555-0100.

Best way to reach you
Date of birth

You can leave it blank and tell us by phone.

If you start this form and don’t finish it, we may still contact you using the details you’ve entered so far. How we handle your information.

Where is the property?

Start typing and pick the address from the list. If you have more than one property, enter the first one and list the others at the end.

Is this also your mailing address?
Are you buying this property now?

Enter 1 for a single-family home.

Is there a mortgage on it?
About the building

Insurance companies ask for the years things were last updated. Leave anything blank if you aren’t sure and we’ll work it out together.

Is there a pool?
Any pets at the property?
Any insurance claims in the last five years?
About the rental
Who owns the property?
About the vacant property
What is vacant?
Is renovation work planned or under way?
About the flood coverage
Does the property have a flood policy now?
Do you have an elevation certificate?
Is a lender requiring flood insurance?
Has the property flooded before?
About the business

Include part-time.

What the business needs covered
What do you need covered?

Choose all that apply.

Where does the business operate?
What kind of place is it?

The main place the business works from. Start typing and pick the address from the list. If it has no fixed location, leave this blank and give the mailing address below.

Is this also the mailing address?
Are you buying or leasing this space now?
Workers compensation
Do you have a workers compensation policy now?
Should owners or officers be covered?
Do you use subcontractors?
About the construction project
What kind of project is it?
Who is doing the work?
About the excess liability policy

An excess liability policy sits above your other policies, so we’ll ask about your current home and auto coverage when we call.

How much coverage are you looking for?
Do you own a boat or other watercraft?
Timing, and anything else
Is this insured now?

Other properties, questions, or a good time to call.

Please don’t include Social Security, driver’s license, or bank account numbers. If we need anything like that, we’ll collect it securely later. Sending this form doesn’t start or change any coverage.

Bloom Realty & Insurance
3542 Atlantic Avenue, Atlantic City, NJ 08401
609-345-2203 · info@bloomrealtyinsurance.com · bloomrealtyinsurance.com