Waterman-Neely Home Quote Request

Fill these fields out to obtain accurate pricing, any indication of rates provided are subject to underwriting, verification of information and acceptance by the Insurance Company. If you have any questions while filling out this form, please feel free to call our office at (217)483-2441.

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Personal Information
Name:
SSN:
Address:
City:
State:   Zip:

Phone Numbers
Day Time Number:
Evening Number:
Best Time To Call 
E-mail:

Underwriting Information
STORIES CONSTRUCTION FOUNDATION ROOF
1-Story 
1 1/2-Story 
2-Story 
Split Level 
Bi-Level		 Frame or Stucco 
Masonry
Masonry&Frame 
Frame&Masonry		 Basement 
Crawl Space 
Slab 
Family Room or Den		 Asphalt Shingle 
Wood Shingle 
Tile or Slate 
Other 
Age of Roof 


Policy Type
# of Units
Year Built Square Feet
Year Purchased
Purchase Price
Plumbing Year 
Last Update		 Drains
Electrical System Last Update
Central Alarm
Heating Last Update
Central Air
# of Fireplaces
# of Bathrooms
Garage # of Car Garage
Size of Decks
Swimming Pool
Flood Area
Mine Subsidence
Area


Prior Losses Past 5 Years
Bankruptcy Ever Filed

Current Insurance Information
Insurance Carrier
Expires
Deductible

Current Insured Values
Dwelling Personal Liability
Personal Property Medical Payments
Personal Injury Scheduled Property
Flood Coverage Other Coverage 
(Business/Hobby/Farm)

Other Coverage or Special Needs

 

 

Waterman-Neely
Insurance Professionals Inc
215 N. Main Street
Chatham, IL 62629

Phone: 217.483.2441
Toll Free: 888.483.6318
Fax: 217.483.6138
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