Homeowners Insurance Quote Request

Applicant Information

What information will you need?

You will need information on the style, features and construction materials of the home, utilities and any updates including the year, coverages and deductibles desired, homeowners master policy coverages, values of content possessions, and any past claims or policy non-renewals.¹

Live in MA? Please apply here.
Or if you live outside of MA, NH, CT, ME, CO or GA, please contact us directly at 508.263.6978.

First, Tell Us About Yourself . . .

First name:

Please enter a first name

Last name:

Please enter a last name

Are you a DCU member?

yes no

Date of birth:

Employer:

Occupation:

Number of years:

Is there a second insured?

yes no

First name:

Last name:

Is the second insured a DCU member?

yes no

Date of birth:

Employer:

Occupation:

Number of years:

Address of property to be insured:

City:

State:

Zip:

County:

Fire department:

Mailing address (if different):

Phone:

Please enter a telephone number

Email address:

Please enter an email address

Are you financing through DCU Mortgage?

yes no

¹ Insurance companies use information gathered from you and often from outside sources about your insurance claim history, property and credit history. This allows them to determine the proper insurance premium pricing and provide a more accurate quote. Accessing your credit information for this purpose has no impact on your credit rating. By submitting this form, you are authorizing DCU Insurance and/or our insurance carriers to access your insurance reports.

* Required fields.

Home Information

Next, tell us about your home . . .

What year was your home built?

Estimated market value ($):

Is your home?

one family two family
three family four family

Is this property:

  your primary home?
  secondary/seasonal?
  income/rental home?

What style is your home?

  1 story (ranch)         1.5 story (typical cape)
  2 story (full dormer cape)         2 story (colonial)
  2.5 story (extended colonial)         split-level
  raised ranch

What is the TOTAL LIVING AREA of your home, including any additions (sq. ft.) (exclude finished basement)?

Check all the following additions your home has:

wood deck breezeway
porch cathedral ceilings

Approximate sq. ft. of wood deck:

Approximate sq. ft. of breezeway:

Is the breezeway:

enclosed? screened? open?

Approximate sq. ft. of porch:

Is the porch:

enclosed? screened? open?

What percentage of your home is cathedral ceilings?

Please check all of the following additional features/items of your home:

  skylights         bay windows
  bow windows         picture windows
  glass sliding doors         atrium windows
  atrium/french doors         attached hot tub
  greenhouse         burglar alarm
  wet bar         garage
  detached structures on the premises

How many skylights?

How many bay windows?

How many bow windows?

How many picture windows?

How many glass sliding doors?

How many atrium windows?

How many atrium/french doors?

How many hot tubs?

Approximate sq. ft. of greenhouse:

Burglar alarm percentage?

How many wet bars?

Is the garage:

attached? basement? built-in?
carport? detached?

How many cars can be parked in the garage?

one car two cars three cars

Please describe the detached structure(s):

Does your home have a full basement?

yes no

What percentage is finished?

Is the basement a walk-out basement?

yes no

What percentage is slab?

What percentage is crawl space?

What percentage is on piers?

How many kitchens are in your home?

Please indicate if your kitchen(s) have the following special features:

  corian, granite, or authentic marble countertop
  center island unit with cabinets or sink
  walk-in freezer
  special or commercial grade appliances

How many bathrooms are full (tub/shower, sink, toilet)?

How many bathrooms are half (sink, toilet)?

Please indicate all grades and qualities of kitchen(s) and bathrooms:

standard custom designer

Is this home under construction or renovation?

yes no

Please give description of construction/renovations and approximate date of completion:

Do you open your property to Room/Home Sharing Arrangements including but not limited to Airbnb, VRBO, or Flipkey?

yes no

Materials Information

Tell us about the materials found in your home . . .

Exterior Wall

What is the primary exterior wall material?

Is there a secondary exterior wall material?

yes no

Which best describes the exterior wall materials found in your home?
Please indicate materials as percentages. Percentages should total 100%.

Wood Siding

Aluminum Siding

Vinyl Siding

Wood Shakes

Brick Veneer

Stone Veneer

Stucco/Frame

Block

Solid Block

Solid Stone

Stucco/Masonry

Log

T1-11

Wall Finishes

What is the primary wall finish?

Is there a secondary wall finish?

yes no

Which best describes all the wall finishes in your home?
Please indicate wall finishes as percentages. Percentages should total 100%.

Paint

Sponge Paint

Paper

Paneling

Ceramic Tile

Brick

Stone

Marble

Knotty Pine

Interior Walls

What is the primary interior wall material?

Is there a secondary interior wall material?

yes no

Which best describes all your interior wall materials in your home?
Please indicate wall finishes as percentages. Percentages should total 100%.

Dry Wall

Plaster

Studs only

Roof Cover

What is the primary roof cover?

Is there a secondary roof cover?

yes no

Which best describes the roof covers on your home?
Please indicate roof covers as percentages. Percentages should total 100%.

Asphalt

Metal

Slate

Architectural Shingles

Wood Shakes

Built-up Tar & Gravel

Rubber

Ceilings

What is the primary ceiling material?

Is there a secondary ceiling material?

yes no

Which best describes your ceiling materials in your home?
Please indicate ceiling materials as percentages. Percentages should total 100%.

Dry Wall

Plaster

Acoustic Tile

Wood

Floor Finishes

What is the primary floor finish?

Is there a secondary floor finish?

yes no

Which best describes the floor finishes in your home?
Please indicate floor finishes as percentages.

Hardwood

Wall-to-wall carpet

Wool/berber carpet

Wall-to-wall carpet over hardwood

Parquet

Vinyl

Ceramic tile

Marble tile

Special Possessions

Next, tell us about any special possessions . . .

Do you need to schedule any high-valued items such as jewelry, furs, art?

yes no

Please check all high-valued items currently residing in your home:

  jewelry         cameras         antiques
  furs         coins         fine arts
  china/crystal         silverware
  musical instruments         firearms
  computers over $1000         other

Recent appraisals will be required.

jewelry value ($)

cameras value ($)

antiques value ($)

furs value ($)

coins value ($)

fine arts value ($)

china/crystal value ($)

silverware value ($)

musical instruments value ($)

firearms value ($)

computers value ($)

other possessions value ($)

Are there any animals on the property?

yes no

What type(s) and breed(s)?

Is there a swimming pool?

yes no

Is the swimming pool . . .

in ground? above ground?

Does the swimming pool have a slide?

yes no

Does the swimming pool have a diving board?

yes no

Does the swimming pool have a fence around it?

yes no

Is the swimming pool fence locked?

yes no

Is there a trampoline on the property?

yes no

Utilities Information

Next, tell us about your utilities . . .

What is your home's primary source of heat?

oil gas
electric other

Where is the oil storage tank located?

  underground         outside, above ground
  indoors/basement on masonry floor
  indoors/basement on non-masonry floor

Bodily injury and/or property damage arising out of the escape of liquid fuel (oil) is excluded. Do you want to add additional coverage to your homeowners policy to provide coverage for this type of loss?

yes no

When was your primary source of heat last serviced?

Do you have a secondary source of heat?

yes no

What type?

Do you have a sump pump in your basement?

yes no

Does your home have central air conditioning?

yes no

Does the heat and air conditioning share the same ducts?

yes no

Does your home have a central vacuum system?

yes no

Does your home have any fireplaces?

yes no

What types of fireplaces do you have?

single double triple

* Double is two fireboxes and one chimney.
** Triple is three fireboxes and one chimney

How many single fireplaces?

How many double fireplaces?

How many triple fireplaces?

What type(s) of fireplace(s) are these?

masonry metal freestanding

How many masonry fireplaces?

How many metal fireplaces?

How many freestanding fireplaces?

Have there been any major updates to wiring, plumbing, heating, roofing or a chimney since the dwelling was built?

yes no

Please note that these coverages are not covered losses on a standard policy

Please check all areas that have had major updates:

wiring plumbing heating
roofing chimney

Is the wiring update a:

partial wiring update?
full wiring update?

Year of wiring update

Is the plumbing update a:

partial plumbing update?
full plumbing update?

Year of plumbing update

Is the heating update a:

partial heating update?
full heating update?

Year of heating update

Is the roofing update a:

partial roofing update?
full roofing update?

Year of roofing update

Is the chimney update a:

partial chimney update?
full chimney update?

Year of chimney update

Do you have a wood/pellet/coal stove in your home?

yes no

Number of stoves:

Is the stove:

wood? pellet? coal?

Is the stove:

freestanding? insert?

Is the stove contractor installed?

yes no

What does your electrical system use?

circuit breakers fuses

Does your home use Knob and Tube wiring?

yes no

Number of amps:

100 200 other

Coverages Information

Tell us About the Insurance Coverages You Desire . . .

Select the desired deductible for this policy:

$500 $1000
$2500 other

Please explain your other desired deductible

Select your desired personal liability coverage amount:

$500,000 (agency standard) other

What other personal liability amount do you desire?

Do you want additional coverage for water back up of sewers and drains?

yes no

Do you also wish to purchase flood or earthquake insurance?

yes no

Do you have a need for Umbrella Liability Protection?

yes no

Please choose your desired Umbrella Liability Protection amount:

  $1 million         $2 million
  $3 million         $4 million
  $5 million         other

What other Umbrella Liability Protection amount do you desire?

Is there a homeowners association?

yes no

What insurance company is the master policy with?

Additional Information

Finally, Just a Few More Questions . . .

Is this a rental unit?

yes no

Have your rental unit(s) been deleaded?

yes no

Do you wish to purchase the lead-poisoning buy-back endorsement for rented property?

yes no

First Mortgage Co.:

Second Mortgage Co.
(if applicable):

Is this a new purchase?

yes no

Closing date:

How much dwelling (Coverage A) insurance do you currently have?

Do you own any watercraft or any other type of recreational vehicle?

yes no

Please describe:

Have any applicants had a foreclosure, repossessions, or bankruptcy in the last 5 years?

yes no

Number of claim free years (0-20)?

Has your coverage been declined or non-renewed for any reason, in the last 3 years?

yes no

Is any business conducted on the premises?

yes no

Do you have any full-time or part-time residence employees (nannies, chefs, etc.)?

yes no

Please indicate any protective devices in your home:

  fire         burglar         smoke
  sprinkler         fire extinguishers
  deadbolt locks

Are alarms:

local? central station?

Any questions or comments?

Do you own any other land?

yes no

Please describe any structures on it:

Is there an additional residence owned, occupied, or rented?

yes no

Please describe:

Are there any smokers living in your household?

yes no

Are you located more than five miles away from a fire station?

yes no

Are you located more than 1000 feet away from a fire hydrant?

yes no

Any flood, brush or landslide hazards?

yes no

Homeowners Insurance Quote Request

For members living in NH, GA, CT, CO or ME

Applicant Information

First, Tell Us About Yourself . . .

Home Information

Next, tell us about your home . . .

Materials Information

Tell us about the materials found in your home . . .

Exterior Wall

Wall Finishes

Interior Walls

Roof Cover

Ceilings

Floor Finishes

Special Possessions

Next, tell us about any special possessions . . .

Utilities Information

Next, tell us about your utilities . . .

Coverages Information

Tell us About the Insurance Coverages You Desire . . .

Additional Information

Finally, Just a Few More Questions . . .