Metlife Auto & Home - Auto And Home Fact Finder

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MetLife Auto & Home
Auto and Home Fact Finder
For a no-obligation quote, fax or email this form to your agent:
Maurice Sobel
Phone: 703-771-8594
Fax: 1-888-934-2009
Concerned about Identity Theft? Our standard auto, homeowners, renters and condo policies include
Identity Theft Service at no additional cost.
Name:_________________________________________________________ Email:___________________________________
Street Address:_____________________________________ City:_____________ State____ Zip_______ County___________
Home Phone_________________ Work Phone____________________ Prefer to be contacted where/what time_____________
Employer______________________________________ Hire date:_______________ MetLife Life Insurance Policy? YES/NO
Auto Insurance
Auto Policy Expiration Date___________ Present Insurance Company_____________________ Current Premium__________
Present Coverages (please circle) 25/50 50/100 100/300 250/500
Deductible (please circle) 250 500 1000
DRIVERS IN HOUSEHOLD
Marital
Last 3 yrs:
Last 3 yrs:
Name
Date of Birth
Driver’s License Number
Sex
Status
Tickets
Claims
ALL VEHICLES IN HOUSEHOLD
Garage
Miles to
Year
Make
Model
Who Drives
Y/N
Work/School
Homeowners Insurance
I want to insure a
Home
Condo or Townhome
Renters
Landlord Dwelling
Vacation Home Other_________
Current Dwelling Coverage Amount________________ Market Value_______________ Current Premium_______________
Liability (please circle)
100K
300K
500K
1M
Deductible (please circle) 500
1000
2500
Value of Contents (renters only) ____________________ Years at current address________ Claims in last 3 years___________
Year Built___________ Square Feet______________ Style of Home_________________ Type of Siding__________________
Trampoline: Y / N Security System: Y / N Age of: Roof________ Electrical_______ Plumbing_______ Heating_________
Number of baths: Full_______ Half_______
Distance to Fire Hydrant________ Miles to Fire Department____________
Value of property you want to schedule such as jewelry, fine art, or expensive computer equipment________________________
Dog: Y / N If yes, what breed:_________ Basement Y / N Swimming Pool: Y/N Garage: YES/NO # of bays:_______

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