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Personal Information

First Name:

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Current Address: (include city street zip)

Phone number:

Email:

Occupation:

Current Home insurance

I currently have a home insurance policy

Home Information

Year built:

Type:

Stories:

Construction:

Foundation:

Age of Electric:

Age of Plumbing:

Age of Heating:

Protection Devices Installed:

Smoke Detectors

Fire Extinguisher

Dead Bolts

Central Burglar/Fire Alarm

Additional Exterior Features

Deck

Screened-in porch

Other (if other please indicate in comments section)

Additional Information

I'd like my jewelry to be covered

I have a dog

Coverage Options

Appliance breakdown

Earthquake

Flood

Identity theft

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Mayers Insurance Agency
1523 Fairmont Ave
Fairmont, WV 26554

Phone: 304-366-0821
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Hours of Operation:
Monday - Friday 9:00AM - 4:30PM
Saturday - Closed
Sunday - Closed

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