Home > Personal Lines Questionnaire This questionnaire is intended to start the quoting process. We will call you shortly after completion to collect additional needed information. Thank you for choosing the Maloney Group at Robertson Ryan Insurance for your insurance needs. Who is your Agent?(Required)Select OneRyan MaloneyGarrett MaloneyTerrence MaloneyIf you are part of a Condominium or HOA, what is its name?If the Home titled in the name of a Trust, please listHome Address(Required) Address Address Line 2 City State Zip Code Residence Type(Required) Primary Residence Secondary Residence Is this a Rental/ Income Property?(Required) Yes No Year Built(Required)Year Purchased(Required)Home Sq. Ft.(Required)If you have a Garage, which best describes it? Attached Detached Garage Sq. Ft.(Required)Number of Garage Stalls(Required)Roof Type(Required) Asphalt Shingles Ceramic Tile/ Slate Wood Shake Flat - Tar Gravel Flat - Rubber Membrane Other Age of Roof (Years)(Required)Age of Electrical (Years)(Required)Age of Heating & Air Conditioners (Years)(Required)Age of Plumbing (Years)(Required)Number of Bathrooms(Required)Number of Fireplaces(Required)If you have a Fireplace, what type? Gas Wood Both Is there a Wood Stove(Required) Yes No Do you have a Basement?(Required) Yes No Is there a Sump Pump?(Required) Yes No If yes, you have a basement, it is finished?(Required) Yes No Does the Sump Pump have a battery backup?(Required) Yes No Is there a swimming pool?(Required) Yes No Is there a trampoline?(Required) Yes No Type of Heating?(Required) Forced Air Radiator Other Central Air(Required) Yes No List all Pets(Required)If there is a home business, please describe(Required)Person 1Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Email(Required) Gender Identification(Required)Marital Status (Discounts May Apply)(Required)Phone Number(Required)Highest Level of Education (Discounts May Apply)(Required) High School Associates Some College Bachelors Graduate Doctorate Drivers License NumberAuto Make(Required)Auto Model(Required)Auto Year(Required)Auto VIN(Required)Miles Driven Annually(Required)Do you use this Auto for Business Purposes?(Required) Yes No Person 2Name First Last Date of Birth MM slash DD slash YYYY Email Gender IdentificationMarital Status (Discounts May Apply)Phone NumberHighest Level of Education (Discounts May Apply) High School Associates Some College Bachelors Graduate Doctorate Drivers License NumberAuto MakeAuto ModelAuto YearAuto VINMiles Driven AnnuallyDo you use this Auto for Business Purposes? Yes No If any additional drivers in household, please list:
