Homeowners & Renters Insurance
Quote Request Form
Pennsylvania

To receive a quote, please fill out the form below....


Insured 1:      Date of Birth:       Social Security #:  (Optional)
Insured 2:
     Date of Birth:       Social Security #:  (Optional)
Address:
City, St., Zip:
Home Phone Number:    Cell Phone:
E-Mail Address:
You are a:  This is a 

Current Insurance Information
Insurance Company:  Expiration Date: 

Your Current Coverages
Dwelling Amount Other Structures Contents/Personal Property Liability Limit Medical Payments Other Optional Coverages
Identity Theft
Dwelling Under Construction Coverage
Mine Subsidence
Motorized Golf Cart
In home Office, Private School or Studio in your home
Sinkhole Collapse Coverage
$ Student Living away from Home
Water Craft Liability
  • Only private pleasure or recreational use is eligible
  • Power boats over 26 feet and jet-skis are not eligible.
  • Maximum speed 50 miles per hour.

  • $ Watercraft Hull Coverage
    Water Backup
    Any property that should be schedule, due to its value....
    JEWELRY
    FURS
    SILVER, GOLD & PEWTERWARE
    FIREARMS
    CAMERA & EQUIPMENT
    FINE ARTS
    AMATEUR MUSICAL INSTRUMENTS
    STAMP COLLECTION
    COIN COLLECTION
    CHINA & CRYSTAL
    Type of Dwelling: Property Deductible Year Built Construction Other Information
    Square Footage:    Type of Home: 

    # of Stories: 

    Updates to Home:
    Furnace Year: 
    Plumbing Year: 
    Roof Year: 
    Electrical

    Wire Type:       Fuse Type: 

    Year: 

    Any other coverages, comments and any additional information....

    PROTECTION (Check all that apply).....
    Smoke Detectors?  Fire Extinguishers:  Burglar/Fire Alarm: 
    connected to central station
    Dead Bolts:  Sprinkler System: 

    GENERAL QUESTIONS

    Do you have a wood burner stove?
    Yes
    No
         If YES, was it professionally installed?
    Yes
    No
    Do you operate a business from your home?
    If YES, Type of Business:
    Yes
    No
    Have you ever filed for bankruptcy?
    Yes
    No
    Do you have a trampoline?
    Yes
    No

    CLAIMS INFORMATION...
    DATE WHAT HAPPENED AMOUNT PAID



    Home Page

    E-Mail
    M c G R A T H   I N S U R A N C E   G R O U P

    4170 William Penn Highway, Murrysville, PA. 15668-1890
    (724) 327-8474                  (FAX) 327-7911
    Toll Free: 1-800-977-2999               (FAX) 1-888-800-0034