Foglia Insurance, Inc.
Homeowners Insurance Questionnaire
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FOGLIA INSURANCE, INC.
9456 STATE RD STE 4
PHILADELPHIA, PA 19114
Phone:  (215) 632-5000
Fax:       (215) 637-4180

If you need immediate
assistance, call or visit
our office. E-mail us for all
other questions or to
schedule an appointment.
Your name:
Your email address:
Home Phone:
Work Phone:
Mobile Phone:
Do you own or rent?
Current Address:
City, State, Zip:
Settlement Date:
Property Address:
City, State, Zip:
Choose a Status:
Sale Price:
Mortgage Amount:
Buyer 1:
Buyer 1 Date of Birth:
Buyer 1 SSN:
Buyer 2:
Buyer 2 Date of Birth:
Buyer 2 SSN:
Mortgage Company:
Loan Officer:
Loan Officer Phone:
Property Information
Year Built:
Home Style:
Number of Stories:
Sq Ft (Living Area)
Exterior:
Roofing:
Basement:
Garage:
Deck(s) Sq Ft:
Enclosed Porch Sq Ft:
Open Porch Sq Ft:
Screened Porch Sq Ft:
No. Bathrooms-Full
No. Bathrooms-Half
No. Fireplaces:
No. Wood Stoves
Heating/Cooling:
Prior Insurance
Prior Insurance Co.:
Premium Amount:
Policy No.:
Claims (Last 5-years):
By clicking the Submit For Quote button, you attest that all information provided herein is truthful and accurate.
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