Otter Valley Insurance & Real Estate


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If you would like to receive a free home owner's quote, please fill out the following form and submit it to Otter Valley Insurance. Final premium is subject to verification of information.

Personal Information

Name*

Address

City*

State*

Zip

Phone Number

Email Address*

Current Insurer

Expiration Date

Construction Type

Year Built

Distance to hydrant

Do you have smoke detectors?	Yes	No
Do you have fire extinguishers?	Yes	No
Do you have dead bolt locks?	Yes	No

Amount of Insurance Requested
Dwelling*
Contents*
Liability*
Deductible Requested*

How would you like us to respond*

Please enter any questions or comments below. If you have any items to be scheduled such as jewelry, paintings, silverware, computer equipment, etc., please enter item description and value.

You understand that there is no coverage in force until an application is approved and premium is received by the company. You certify that the statements made on this quote request are accurate to the best of your knowledge. Any person who, with the intent to defraud or deceive, submits an application containing any false, incomplete or misleading information or helps in any manner to commit fraud may be subject to civil penalties and criminal prosecution for insurance fraud.