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HUGHES ASSOCIATES, INC.
71-14 Myrtle Avenue
Glendale, NY 11385

Phone: (718) 456-8646
Phone: (516) 354-2171
Fax: (718) 456-8797

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Personal Information
First Name			Last Name
Address1
Address2
City			State Zip
Home Telephone			Email Address
Home Owners Information Only
Previous Address (If you have been at the above address for less than 3 years)
Address
Address2
City			State Zip
Mortgage Information
Mortgage Company Name
Mortgage Company Address
City			State Zip
Loan Number
Do you currently have homeowners insurance?			What is the expiration date of your current Homeowners Insurance Policy?
Do you own or rent?
Coverage amount or limit of liability requested
Home			Other structures (detached garages for example)
Personal property or contents			Loss of use
Personal Liability Limit?			Medical Payments
Deductible for property coverages?
Construction Type:			Year Built?
Market Value			Distance to nearest fire hydrant in feet
Distance to nearest fire hall in miles			Do you have smoke detectors?
Do you have burglar alarms?

Is any business conducted within this home?
Has any coverage been declined, cancelled or not-renewed during the last 3 years?

If you rent answer the following questions:
What is the replacement cost value of your personal items?			What deductible would you prefer for your rental policy?
What are your Personal Liability limits for your rental policy?

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Hughes Associates, Inc. is conveniently located close to Glendale, Middle Village, Richmond Hill, Woodhaven, Ridgewood, Maspeth Queens, and Cypress Hills Brooklyn, NY.

We service all of the 5 boroughs - Queens, Brooklyn, Manhattan, Staten Island, and Bronx, New York as well as Westchester, Nassau County, Suffolk County, Rockland County, Putnam County and Upstate New York. We also service Parts of Connecticut (CT) and New Jersey (NJ)