Huntress Insurance
Huntress Insurance
Voted best insurance agency in Melrose
Huntress Insurance • 6 Eastman Place – Melrose MA 02176 • Ph. 781-665-0303
Huntress Insurance
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Click on the AUTO, HOME or LIFE links for the Insurance Quote form.
| AUTO | HOME | LIFE |

ONLINE AUTO QUOTE FORM
COVERAGES
PART 1-12

AUTO 1

AUTO 2
 Compulsory Insurance

Limits/Deductible

 Limits/Deductible
1. Bodily Injury To Others

$20,000 per person/$40,000 Accident

$20,000 per person/$40,000 Accident
2. Personal Injury Protection

$8,000 per person

$8,000 per person 
3. Bodily Injury Caused By An Uninsured Auto (Compulsory) Limits $20,000/$40,000

 

 
4. Damage To Someone Else's Property (Compulsory) Limits ($5,000)

 

 
OPTIONAL INSURANCE    

5. Optional Bodily Injury To Others: Guest Occupant Exclusion For Motorcycle

THIS PROTECTS YOU IF
YOU ARE SUED!!!!!

 

 
6. Medical Payments

 
7. Collision

Yes No
If YES deductible

Yes No
If YES deductible
8. Limited Collision

Yes No

Yes No
9. Comprehensive

 Yes No
If YES deductible

 Yes No
If YES deductible
10. Substitute Transportation

 Yes No
If YES per day

 Yes No
If YES per day
 11. Towing & Labor

 Yes No
If YES
Based on underwriting requirements

 Yes No
If YES
Based on underwriting requirements
 12. Bodily Injury Caused By An Underinsured Auto

 

 
 VEHICLE INFORMATION  Principal Garaging City or Town- Auto 1 Principal Garaging City or Town
Auto 2
   Year  Year
   Make, Model Make, Model
   Est. Annual Mileage  Est. Annual Mileage

  Air Bag/Passive Seat Belt
Yes No

  Air Bag/Passive Seat Belt
Yes No
 

Anti-Theft
Yes No

 Anti-Theft
Yes No
 

 Recovery System
Yes No

  Recovery System
Yes No

 

DRIVER INFORMATION  Furnish Information for the applicant & each individual who operates the auto (s)

 #

Name

Date of
Birth

Driver's License #/ State

Date First License

Driver Training

% of Use*

 1

First
Last

 

 Mass

 Other
 Yes No

 Auto 1
Auto 2
 2

First
Last

 

 

 

 Mass

 Other

 YesNo

 Auto 1
Auto 2
 3

 First
Last

 

 

 Mass

 Other

YesNo 

 Auto 1
Auto 2
 4

 First
Last

 

 

 Mass

 Other

YesNo

 Auto 1
Auto 2
 5

 First
Last

 

 

 

 Mass

 Other

YesNo

 Auto 1
Auto 2
 6

 First
Last

 

 

 

 Mass

 Other

YesNo

 Auto 1
Auto 2

How do you prefer to be notified?

Name
Phone#or
Email Address

Honor Roll Student

School Greater than 100 miles away?

Loss Free for 6 years?

In Control Advanced Driver Training?

* required field
AUTO FORM - THANK YOU

 

 
Quote - | AUTO | HOME | LIFE |

 

ONLINE HOMEOWNER'S QUOTE FORM

Applicant's Name:

Mailing Address:

How do you prefer to be notified?

Name

Phone# or

Email Address

Location of Property (if different from above):

COVERAGES/LIMITS OF LIABILITY

Dwelling: $

Year Built No. of Family

Personal Liability: Deductible:

ENDORSEMENTS

Jewelry $

Camera & Equipment $

Computer $

Art $

Golf Equip. $

Musical Instruments $

RATING/UNDERWRITING

Frame Aluminum Siding Masonry Plastic Siding

Masonry Veneer SuperiorOther

Usage Type

Distance to Hydrant:ft.

Distance to Coast:mi.

Protection Device Type:
Central Station Local Gong Direct Ring Fire Smoke
Burglary Fire Extinguisher Occupied Daily Visible to Neighbors

Heat Type:

If Oil, where is tank?

GENERAL INFORMATION

Explain all "YES" responses in Remarks at the end of form

1. Any coverage declined, canceled or non-renewed during the last 3 years?

Yes No

2. Any losses during the last 6 years? Yes No

3. Do you own a trampoline? Yes No

4. Do you own a pool? Yes No If yes, is there a diving board? Yes No

5. Do you have a pet? Yes No If yes, what kind and breed?

6. Are you a smoker? Yes No

7. Date of birth Social Security #

Please explain any "YES" answers below:

HOME QUOTE - THANK YOU

Quote - | AUTO | HOME | LIFE |

 

ONLINE LIFE QUOTE FORM

Applicant's Name:

Mailing Address:

How do you prefer to be notified?

Phone# or

Email Address

Date of Birth

Gender

Have you ever used tobacco?

Yes No

If yes, when was last use?

Amount of Coverage

Comments:
LIFE - THANK YOU

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