IMPORTANT INFO:
In addition to submitting this form online, this form can be printed and faxed to:
Fax: (212) 937-3923

Print Application - PDF

or call today for an
EXPRESS PHONE QUOTE:
877-ARMofNY (276-6369)
 and talk to an insurance specialist.

- LOW PRICES
- LOW DOWN PAYMENT
- LOW MONTHLY PAYMENTS
- IMMEDIATE COVERAGE
- "A+" RATED CARRIERS
- PROFESSIONAL SERVICE
- PAYMENT PLANS
- CREDIT CARDS


COVERAGE DEFINITIONS

PROPERTY
CVG. A - Dwelling
 Covers the dwelling and structures attached to the dwelling, as well as materials and supplies for repair and construction of such structures if they are located on or next to the residence premises.

CVG. B - Other Structures
 Covers buildings on the described premises that are separated from the dwelling by clear space.

CVG. C - Personal Property
 Provides coverage for personal property owned or used by an insured while it is anywhere in the world.  It is important to note that each policy may have exclusions not covered as personal property and does not include theft outside the premises.

CVG. D - Loss Of Use
 Provides two types of coverage.  First, if a covered property loss makes the residence premises uninhabitable, the policy will cover addition living expenses related to maintaining the insured's normal standard of living.

Second, if a covered loss to the insured's property makes a past of the residence premises that is rented to others or held for rental by the insured uninhabitable, the policy will cover the loss of fair rental value, less any expenses that are not required while the premises is uninhabitable.

DEDUCTIBLE
 The maximum amount you as the policy holder will pay in the event of a loss.

LIABILITY
CVG. E - Personal Liability
 Covers damage that the insured becomes legally obligated to pay because of bodily injury or property damage caused by an occurrence to which coverage applies.

CVG. F - Medical Payments To Others
 Pays all necessary medical expenses incurred within three years of an accident that causes bodily injury.

Homeowners / Renters Insurance Quote Form

Our new customers report savings of over $300-$700 annually.*

Do you want to save on your homeowners / renters insurance?

Find out now - get a quote!

Our satisfaction is saving you money.   We make it easy for you to save and keep money where it belongs . . . In your pocket for more important needs - You!

For faster service refer to a copy of current policy.
First time Homeowner or Renter?  No problem, just complete this form.

 OWNER / RENTER INFORMATION
Name: Date of Birth:
 
Occupation:  SS#:
 

Spouse Name (if applicable):		  
Spouse Date of Birth:
 
Spouse Occupation:  Spouse SS#:


 
# of Consecutive Weeks in the Year
Home is NOT Occupied
Do You Own Other Residential Property Y N
     If You Own Other
     Property, Explain
Do you Own Any Pets? Y N
     Have Pets Bitten Anyone? Y N
     Type and Breed (i.e. dog/poodle)

 LOCATION INFORMATION

Address of Property:

City:

State:         Zip:
  
# of Bedrooms
# of Baths
Do You Own or Rent This Property OWN RENT
Is Home / Building Under Construction Y N
Date Moved in or Planning Move in

 CONSTRUCTION INFORMATION
Type of Residence
    Other (Type of Residence)
Construction Type
    Other (Construction Type)
Roof Type
    Other (Roof Type)
    Is Roof Flat or Sloped? FLAT SLOPED
If a House - Is It Attached? No 1 SIDE 2 SIDES
Year Built
# of Floors (Excl. Basement)
SqFt of Living Space (Excl. Bsmnt & Garage)
If a House - Is There a Basement? Y N       N/A
    Is Basement Finished Y N       N/A
    Sq. Ft. of Basement (if applicable)
# of Apartments/Units (If Building)

PROPERTY UPDATES
ROOF
(Updated)		 ELECTRIC
(Updated)		 HEATING
(Updated)		 PLUMBING
(Updated)
Yes No Yes No Yes No Yes No
(If yes, year)
 (If yes, year)
 (If yes, year)
 (If yes, year)

Wiring Type FUSES        CIRC. BREAKER
Plumbing Type COPPER    PVC
Heating Type Oil   Gas   Coal   Elec.
Central Air Conditioning? Y N
# of Garage Doors? 0 1 2 3 or More
     Is Garage Attached (no house above)? Y N
     Is Garage Built In? (house above)? Y N
Is There a Pool? Y N
     Is Pool Fenced-in? Y N
     Pool Type? Above Ground In-Ground

 BASIC FIRE SAFETY PROTECTION INFORMATION
Distance from Fire Protection (Hydrant)
Distance from Fire Station
Is Your Area A "Brush" Area? Y N
Smoke Alarm? Y N
Smoke Detectors? Y N   if Yes, how many
Fire Extinguishers? Y N   if Yes, how many
Interior Automatic Fire Sprinklers? PARTIAL FULL NONE
Fire Alarm
Theft Alarm
Deadbolts on All Doors? Y N

 REQUESTED COVERAGE
CVG. A  Dwelling - Replacement Value
               Dwelling - Market Value
CVG. B  Other Structures Value
CVG. C  Personal Property / Contents
CVG. D  Loss of Use
DEDUCTIBLE
CVG. E  Liability Limits Requested
CVG. F  Medical Payments to Others
ADDITIONAL COVERAGE REQUEST
Water Backup Coverage
Off-Premises Theft Cvg? Y N
Flood Cvg. Y N
    Is Flood Cvg. Required? Y N
    Distance to Water?

SCHEDULED ITEMS NOT INCLUDED IN BASIC CVG. (List Values)
JEWLERY FURS ARTS COLLECTIBLES
CAMERA EQUIP. SPORTING EQUIP. OTHER

 CURRENT / PRIOR COVERAGE INFORMATION
Currently Insured? Y N
     Policy #
     Policy Expiration Date
     Did Policy Cancel? Y N
     If Cancelled - Why? (Pymnt, Underwriting, etc.)
     How Long Insured?
     Current Annual Premium?
Losses-Claims in the
Last 3 Years?		 Y N
If Losses and/or Claims
List - Date, Amount Paid and
Description of Each Loss

 CONTACT INFORMATION
First Name:

Last Name:

*Email:

Phone:                        Fax:
  
Questions / Comments / Notes

 Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone!
Thank you for completing this Form

ARM-Capacity's Policy on sharing information:

  1. We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
  2. We will not distribute information to other parties other than for insurance underwriting purposes.
  3. *Average reported savings based on ARM-Capacity survey data through September 2007.

Click Button Below When Complete

OR PRINT AND FAX THIS FORM TO
FAX: 212.937.3923

or Call:
888.ARMofNY - 888.276.6369
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2008 (c) ARM-Capacity of New York, LLC. All rights reserved.  T: 888.276.6369  F: 212.937.3923