(410) 882-0077 Baltimore, MD

Hammer Insurance Agency Inc. & Ford Insurance

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Contact Name *

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Current Insurance Information

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Insurance Information

Deductible Desired

Amount of Liability Desired

Earthquake Coverage Desired?
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Windstorm Coverage Desired? (not applicable in all states)
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If Any Pets, What Breed?

Dwelling Information

Is this home owner occupied or a rental?
Owner Occupied Rental

Estimated Replacement Cost

Square Footage

Year Constructed

Is Your Home over 20 Years Old? If so, What Updates Have Been Made?

Age of Hot Water Heater?

Roof Type and Age?

How Many Floors?
1 Story
1.5 Story
2 Story
Bi-Level
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Type of Construction
Wood
Stucco
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Other Home Features (check all that apply)

Dead Bolts

Smoke Detectors

Fire Extinguisher

Central Station Fire Alarm

Central Station Burglar Alarm

Located within 5 miles of Fire Station

Located 1000 feet from Fire Hydrant

Swimming Pool

Trampoline

Home Located within City Limits

Claims List any claims in past 3 years:

Date of Claim

Amount Paid

Claim Type

Description

Date of Claim

Amount Paid

Claim Type

Description

Date of Claim

Amount Paid

Claim Type

Description

Personal Property Estimated value of your personal property:

Jewelry & Watches

Furs

Silver

Firearms

Stamp and Coin Collections

Fine Arts and Breakable Items

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Hammer Insurance Agency Inc. & Ford Insurance | 3527 E. Joppa Rd. | Baltimore, MD 21234 | (410) 882-0077

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