Real Estate Tools
- Home Search
- Home Evaluation

Insurance Tools

Academy Tools
- Pre-License Class
- Real Estate Ready

Resources

Get a Quote

Complete the form and we will get working on finding you the best insurance quote we can. Or feel free to give us a call at
(413)693-2460 and we would be happy to help you over the phone.

First Name *

Last Name *

Email *

Phone *

Home Address *

How did you hear about us? *

Get a quote for? *

Date of birth *

Driver's License # *

Current ins carrier

# of years with carrier?

Has your insurance ever been canceled for non-payment?

Yes

If yes when and with which carrier?

Household members with licenses

Vehicle Year

Vehicle Make

Vehicle Vin#

Vehicle Year

Vehicle Make

Vehicle Vin#

Are you a member of AAA?

Yes

Roughly how many miles per year do you drive?

Please upload a copy of your driver's license

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Do you own or rent your home?

Rent

Own

Other

How long have you lived here?

Have you had any claims in the last 5 years?

Yes

Has your insurance been canceled/non-renewed in the last 5 years?

Yes

Swimming Pool (check all that apply)

In-Ground

Above Ground

Fenced in

Diving Board

Slide

Fireplace (check all that apply)

Yes - wood burning

Yes - gas burning

Wood or pellet stove

Trampoline?

Anyone is the home smoke?

Yes

Are you within 1000 ft from a fire hydrant

Yes

Any updates in the last 25 years?

Wiring

Plumbing

Heating/AC

Roof

Do you have Circuit Breakers?

Yes

Are you within five miles from a fire station?

Yes

What type of basement do you have?

Any other structures on the property? (check all that apply)

Central AC

Yes - shares ductwork with heating system

Yes - separate system

Do you have a garage? (check all that apply)

Attached

Detached

1 Car

2 Car

3+ car

Carport

Under house

Other

If you have your current policy available please upload it below.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 3 Files )

I Consent to Receive SMS Communications from BKaye. You can reply STOP to unsubscribe at any time.

(413) 693-2460

[email protected]

1260 Sumner Ave

Springfield, MA 01118

Get a Quote

Complete the form and we will get working on finding you the best insurance quote we can. Or feel free to give us a call at(413)693-2460 and we would be happy to help you over the phone.

Complete the form and we will get working on finding you the best insurance quote we can. Or feel free to give us a call at
(413)693-2460 and we would be happy to help you over the phone.