1000 Liberty Road
Suite 100
Eldersburg, MD 21784
(410) 781-4672
(410) 795-2000
(888) 550-3858
 
  Monday- Thursday:
9:00am - 5:30pm
  Friday:
8:30am - 5:00pm
  After Hours by Appointment
 
 

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For quotes and to discuss your insurance options, please contact us today, or fill out the secure form below:

If you would prefer to give the more detailed information to us over the phone, please fill out the highlighted areas only and we'll give you a call:
 

Name
Physical Address
City   State   Zip

Mailing Address
City   State   Zip

Home Phone
  Work Phone

Best time to call:
Email
 
Have you had continuous coverage for at least 12 months?
Yes No
 
If not, why not?
 
Present
Insurance Co.
Present Coverage Amount
Renewal Date
Occupation
Claims in Last 3 Years 01234+
Square Footage of Living Space
Year Home Was Built

Type Construction
1-Story
1 1/2-Story
2-Story
Split Level
Bi-Level		 Frame or Stucco
Masonry Veneer
Masonry
Foundation

Roof
Basement
Crawl Space
Slab		 Asphalt Shingle
Wood Shingle
Tile or Slate
Other
Age of Roof


Garage Bathrooms
1-Car
2-Car
3-Car
4-Car		 Attached
Detached
Basement
Built-in
Car Port		 # of Full
12345

# of Half
12345

Other Features
 Central Air Conditioning  Central Vacuum
 Wet Bar  Whirlpool Tub
 Security System


Fireplaces Basement
# of Chimneys
12345
# of Hearths
12345
Finished Yes No
Sq. Ft.

Deck, Porch, Patio
Deck sq. ft.
Screened
Patio sq. ft.
Porch sq. ft.
Enclosed Porch sq. ft.
Comments


Mortgages on the Dwelling
# Mortgages
1 2 3 4 5


Do you have any dogs?
# Dogs
No Dogs 1 2 3 4 5


Is there a home-based business on premises?
Yes No
 

Freedom Insurance Agency, Inc.
1000 Liberty Road, Suite 100, Eldersburg, MD 21784.
(410) 781-4672, (410) 795-2000, (888) 550-3858.