Unruh Insurance - Life - Homeowners - Business - Auto - Personal

HOW TO CONTACT US


Name:
Street address:
City:
State:		Zip:
Phone:
Email:
Purchase Price:
Mortgage Amount:
Year of Home:
Style of Home:
# of Floors:
Fire Hydrants:	Yes No
Distance to Fire Department:

Dwelling Amount:
Other Structures:
Personal Property:
Loss of Use:
Personal Liability:
Medical Payments:

List Any Additional Coverages: ( ex: jewelry, collectables, musical instruments, etc.)

Current Insurance Company:
Current Effective Date:
Roof Replaced:
Date Heating Updated:
Date Electrical Updated:
Fuses:	Yes No
Circuit Breakers:	Yes No
Have there been any claims filed on any property in the past 5 years?
Yes No
If Yes,	Date:
	Description of Claim:
	Amount Paid:
Do you own any pets? Yes No
	Type of Pet:
	Breed of Pet:
Do you have a swimming pool? Yes No
Do you have a trampoline? Yes No

Unruh Insurance Agency, Inc. is licensed to conduct business in the state of PA. The information
on this site is a solicitation to conduct business only in the aformentioned state of authority.

© 2007 Unruh Insurance
2350 N. Reading Rd. - Suite 13
(located adjacent to Zia Maria Restaurant)
Denver, PA 17517
GET DIRECTIONS

Toll Free: 1-877-854-3309
Local Phone: 717-484-0822
Fax: 717-484-1031 - Email: kent@unruhinsurance.com

Another Site Designed by Schell's Web Design