Svij@milestoneinsure.com
+1 973-588-5137
110 N. Beverwyck Road, Lake Hiawatha, NJ 07034
Mon-Fri: 8:30-5:00
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Property Information
Property Type
Apartment
Single Family Home
Duplex
Townhome
Mobile Home
Other
Estimated Square Footage
Total Number of Rooms in your dwelling excluding basement and bathrooms
1
2
3
4
5
6
7
8
9
10
11+
Select any additional property features that apply.
Dead Bolts
Fire Extinguishers
Trampoline
Covered Deck/Patio
Swimming Pool
Do you have any of the following breeds of dogs: Chow, Doberman, German Shepherd, Pit Bull, Rottweiler, Wolf Hybrid, or a mix of these?
Yes
No
Policy Information
Replacement value of all possessions
$15,000
$30,000
$50,000
$100,000
$250,000+
Personal Liability Coverage Desired
$100,000
$300,000
$500,000
$1,000,000
Other
Desired Deductible
$250
$500
$1000
$2000
Other
Credit Rating
Excellent
Good
Poor
Unsure
Have you reported any claims or losses to your insurance company within the past 5 years? *
Yes
No
Will this insurance replace an existing policy?
Yes
No
When would you like this policy to start?
Contact Information
First Name
Last Name
Email
Phone Number
Address Line 1
Address Line 2
City
State
Zip Code
Country
Comment