Verma Insurance Agency                                    

Our goal is to provide you with best insurance coverage at a lowest price, coupled with superior customer service and carrier reliability

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Home Quote

Request Home Quote:

Contact Info

First Name: Last Name:
Address: Apt#:
City: State: Zip:
Phone: Email:


Other Info:

Your Date of Birth: Number of Adults:
Referred By:

About Your Home:

Number of Units: Living Sq. Foot:
Year Built: Number of Stories:
   
Flooring:
     Carpet: % Tile: %
     Hardwood: % Vinyl: %
     Marble: % Stone: %
     Other: %
   
Number of Car Garages: Number of Bathrooms:
Number of Fireplaces: Kitchen Countertop:
Swimming Pool/Spa: Deck:
Roof Type: Roof Age:
Foundation:
Exterior Type:
Other Feature/Upgrade:

Info For Discounts:

Burglar Alarm:
Education:

Prior Insurance Information:

Prior/Current Carrier:
Home Purchase Date:
No. Of Claims in last 3 yrs:
Please provide Claim date and details, if any:

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