New Jersey Homeowner Insurance Quote

In addition to New Jersey
Homeowners Insurance, we
also offer affordable Car
Insurance policy premiums
or choose another NJ
family insurance coverage
from the list below.

**Information received from this New Jersey Homeowners Insurance quote

request form sent to American Insurance Services Agency 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 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 New Jersey Homeowners Insurance Policy. We are licensed in New Jersey and

will not provide quotes for other states.

"Your Local New Jersey Homeowners Insurance Policy Agent!"

We offer affordable homeowners insurance policy premiums to residents of the

following New Jersey counties and cities: Union County, Essex County, Bergen

County, Passaic County, Sussex County, Morris County, Warren County,

Hunterdon County, Somerset County, Middlesex County, Monmouth County,

Mercer County, Burlington County, Clark, Newark, Jersey City, Elizabeth, Rahway,

Colonia, Iselin, Avenel, Woodbridge, Port Reading, Carteret, Perth Amboy, Fords,

South Amboy, Metuchen, Plainfield, Dunellen, South Plainfield, Green Brook,

Fanwood, North Plainfield, Cranford, Scotch Plains, Westfield, Union, Millburn,

Springfield, Mountainside, Gillette, Warren, Watchung, Stirling, Millington,

Middlesex, Martinsville, Piscataway, Edison, New Brunswick, Highland Park, North

Brunswick, Sayreville, East Brunswick, Somerset, Milltown, South River, Bound

Brook, Somerville, Bridgewater, Bayonne, Linden, Roselle, Hoboken, Union City,

Weehawken, West New York, Guttenberg, Cliffside Park, Edgewater, North Bergen,

Secaucus, Fairview, Ridgefield, Fort Lee, Leonia, Palisades Park, Englewood Cliffs,

Englewood, Bergenfield, Teaneck, Paramus, Bogota, Ridgefield Park, Little Ferry,

Hackensack, Maywood, Teterboro, South Hackensack, Rochelle Park, Moonache,

Lodi, Hasbrouck Heights, Saddle Brook, Garfield, Elmwood Park, Woodridge,

Carlstadt, East Rutherford, Lyndhurst, Rutherford, Wallington, Passaic, Clifton,

Paterson, Totowa, West Paterson, Little Falls, Great Notch, North Caldwell, Cedar

Grove, Verona, Montclair, Bloomfield, West Orange, Glen Ridge, Belleville, Nutley,

Kingsland, North Arlington, Kearney, Harrison, East Orange, East Newark, Orange,

Irvington, South Orange, Hillside, Townley, Livingston, Wayne, Trenton, Camden,

Atlantic City, Princeton, Vineland, Willingboro, and Toms River, NJ.

New Jersey Homeowners Insurance Coverages & Limits of Liability

Full Name:
Address to be Insured:
City:     State:     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 currently have homeowners insurance?
Current Premium:$ per month
Coverage requested for?
Usage Type:
Years Lived at Address to be Insured:

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

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

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

Building Structure:
Year Dwelling Built:     Dwelling Square Feet:
Primary Heat Type:
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 Location:     Dwelling Occupied By:
Swimming Pool:              Diving Board:
Approved Fence:

Did you have any losses, whether or not paid by insurance, during
the last 3 years, at this dwelling location or any other location?
If the answer to the previous question was "Yes", please explain below.

Date                            Type                            Description of Loss                          Amount of Loss



Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your New Jersey Homeowners Insurance quote request.**

Applicant Information

Policy Endorsements

New Jersey Homeowners Insurance - Dwelling Information

Loss History