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Homeowner
Life
Small & Son, Inc.
16 South Seventh Street Stroudsburg, PA 18360
Phone: (570) 421-0111
Fax: (570) 421- 2678
Homeowner Insurance Quote Form
*Indicates Mandatory Fields
First Name:
*
Last Name:
*
Email:
*
Address:
*
City:
*
State:
*
Zip
*
Home Year Built
*
Style/Number of Stories
*
Square Footage
*
Attached Garage:
- - Choose One - -
Yes
No
Basement:
*
- - Choose One - -
Yes
No
% Finished Basement:
Construction:
Wood Exterior
Brick Veneer
Solid Brick
Aluminum - Vinyl Siding
Log
Manufctured Home
Type of Heat:
Oil
Gas
Electric
Wood/Coal/Pellet Stove
Feet From Hydrant:
Miles to Fire Station:
Any Losses in the last five years? Please explain: