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Request a Home Insurance Quote

Complete our form and we’ll be in touch with your insurance quote.

Let’s Get Started

Step 1Fill out the form.
Step 2Review your options with us.
Step 3Get the coverage you need.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Name*

Prefix* First Name* Last Name*

Email*

Phone Number*

Date of Birth*

Month*

Day*

Year*

May we contact you via text message?*

Yes

By providing your phone number, you agree to receive text messages at the number provided. Standard message and data rates apply. This number will be used for communication between Empire Insurance Agency and you in addition to communication between your insurance carrier and you.

Preferred contact method*

Text

Phone Call

Mail

Property Address*

Street Address* Address Line 2 City* State* ZIP Code*

Is your mailing address different from the property address?*

Yes

Mailing Address

Street Address Address Line 2 City State ZIP Code

Year home built

How many stories?

Foundation type

Siding type

Square Feet

How many kitchens?

How many full & half baths?

Roof Type

Year roof updated

Plumbing type

Year plumbing updated

Electric Type

Year electric updated

Heating type

Year heating updated

Any wood and/or pellet stoves?

Yes

Swimming Pool?

Yes

Trampoline?

Yes

Attached garage?

Yes

If so, how many cars?

Any other structures on the property (garage/barn/shed/etc.)?

Yes

If yes, what type:

Garage

Barn

Shed

Outbuilding

Other

Any decks, porches or patios?

Yes

If yes, please provide square feet

How many acres of land?

Do you own any animals?

Yes

If yes, list type (dog/cat/exotic)

Dog

Cat

Exotic

If dog, list breed(s)

Any claims on any property in the last 5 years?

Yes

Please list approximate date and description of claim:*

(i.e. Jan 2019 roof leak)

Do you have current property insurance?

Yes

With what carrier is your property covered?

What is your current premium?

Purchase price?

If new purchase, when is your closing scheduled?

Month

Day

Year

File

Drop files here or

Max. file size: 2 GB.

Notes to Agent

Consent*

I agree to the privacy policy.

Like most website operators, Empire Insurance Agency collects non-personally-identifying information of the sort that web browsers and servers typically make available, such as the browser type, language preference, referring site, and the date and time of each visitor request. Empire Insurance Agency’s purpose in collecting non-personally identifying information is to better understand how Empire Insurance Agency’s visitors use its website. From time to time, Empire Insurance Agency may release non-personally-identifying information in the aggregate, e.g., by publishing a report on trends in the usage of its website.

Click here to read our privacy policy.

Prefer to speak with someone from Empire Insurance Agency?
Contact us directly.

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4100 Vestal Road, Suite 102
Vestal, NY 13850

607-724-0404 text
570-531-8006 fax
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Empire Insurance Agency exists to make a positive difference by serving our customers with righteousness and the heart of a teacher.

We are licensed in NY and PA.

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