The Shannon Agency » Homeowners Policy Request

June 4, 2019

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The Shannon Agency
Timothy G. Shannon, CLF, AIM, LUTCF

Phone: (800) 999-5729
Fax: (877) 625-9370

Type of home
Name*
Email*
Address
City		State	Zip
Home Phone		Work Phone
Present insurance Co.		Expire Date
Amount of Coverage
Age of house		Age of roof
Occupation		Years at present job
How long at this address		No. of claims in last 3 years
Type of house?	1 Story2 StorySplit Level
Construction type?	Frame/StuccoMasonrymasonry veneer
Square footage?
Roof type?	Asphalt/ShingleTitle/SlateOthers
Do you have a garage?	1-Car2-Car3-CarNone
Garage type?	AttachedDetachedBasement
Are you in a high brush area?	YesNo

Homeowners Policy Request