Formerly Stop Agency, Inc. - Same Faces & Great Service since 1996

Homeowner Quote: Owner Occupied

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information

First Name *

Last Name *

Street *

City *

State *

ZIP / Postal Code *

E-Mail Address *

Primary Phone Number *

Alternate Phone Number

Date of Birth *

How would you rate your credit? *

Current Information

Do you currently have insurance?

Yes: Currently Insured
No: Previous Policy Cancelled
No: New Purchase Pending

Current Insurance Provider (Choose NONE if No Prior)

Months With Company

Current Policy End Date

Dwelling Information

Year Built

Age of Roof? *

1-5 Years
6-10 Years
11-20 Years
+20 Years Old

Number of families living in home?

Number of bedrooms?

Liability Limit

Deductible Amount

Square Footage *

Dogs *

If you have Dogs, please provide Breed & Weight.

Pool *

Claims/Property Losses in Past 5 Years (Please Explain)

How did you hear about us?

Submission Validation

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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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862D Montauk Hwy | Shirley, NY 11967 | Phn: 631.395.1000 | Fx: 631.395.1982